- Email: [email protected]
PP7.8 – 1576 Successful desensitization of oxcarbazepine and ethosuximide after cutaneous adverse drug reactions and HLA genotype in Korea
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
PP7.5 - 1768 Efficacy of long-term adjunctive zonisamide therapy in paediatric patients with partial epilepsy: results of an open-label extension study of a Phase III, randomised, double-blind, placebo-controlled trial Rosati A, Giorgi L, Bradshaw K, Guerrini R. Neuroscience Department, Children’s Hospital Anna Meyer-University of Florence, Florence, Italy – [email protected] Objectives: To assess the long-term efficacy of once-daily adjunctive zonisamide therapy in paediatric patients with partial epilepsy. Material and methods: An open-label extension study of a Phase III, double-blind, randomised, placebo-controlled, multicentre trial was conducted in patients (age 6–18 years) with partial epilepsy receiving one or two antiepileptic drugs (AEDs). Study began with a double-blind transition period (duration 2–11 weeks), during which patients already receiving zonisamide continued at same dose, while those previously receiving placebo switched to zonisamide, initiated at 1 mg/kg/day and up-titrated to a target of 8 mg/kg/day (maximum 500 mg/day). This was followed by an open-label period (duration 45–57 weeks), during which zonisamide dosing could be adjusted according to tolerability/response. Primary efficacy assessment was responder rate during open-label period (response defined as ≥50% seizure frequency reduction from baseline of initial trial). Secondary assessments included seizure freedom rate and reduction in 28-day seizure frequency (from baseline of original trial) during open-label period. Results: In total, 144 patients entered the extension study, of whom 72 had received placebo and 72 had received zonisamide during the initial trial; 99/144 (68.8%) patients completed the study. During open-label period, 81/144 (56.3%) patients were responders (95% confidence interval [CI], 47.7%, 64.5%). Results were similar for patients who initially received placebo (40/72; 55.6%; 95% CI, 43.4%, 67.3%) and zonisamide (41/72; 56.9%; 95% CI, 44.7%, 68.6%). Overall, 16/144 (11.1%) patients achieved seizure freedom during open-label period (95% CI, 6.5%, 17.4%); results being identical for patients initially receiving placebo and zonisamide (for both populations: 8/72; 11.1%; 95% CI, 4.9%, 20.7%). Seizure frequency reduction was maintained throughout the study; the median percentage decrease in seizure frequency being 65.9% during open-label period. Conclusions: The efficacy of adjunctive zonisamide in paediatric patients with partial epilepsy was maintained over a treatment period of >1 year.
PP7.6 - 687 Does vigabatrin treatment for infantile spasms cause visual field defects? An international multicenter study Riikonen R, Carmant L, Dorofeeva M, Hollody K, Krajnc B, Rener Primec Z, Szabo I, Wohlrab G, Sorri I. Kuopio, Finland – raili.riikonen@kolumbus.fi There exists little information how often the vigabatrin (VGB) treatment for infantile spasms (IS) causes irreversible visual field defects (VFDs). The aim of this study was to examine IS patients at school age for visual fields to see whether the VGB treatment in infancy had caused defects. Patients and Methods: This study included 34 children aged 11 (range 8 to 22 years). Six centers were involved in the study. Nine children had tuberous sclerosis (TS), two other symptomatic (mild brain malformations) and the remaining 23 cryptogenic aetiology for their spasms. Visual fields were examined by the Goldmann kinetic perimetry, by the static Humphrey or Octopus perimetry by experienced perimetrist. Visual fields were re-evaluated by the ophthalmologist (I.S). Results: We found typical VGB-attributed visual field defects altogether in 12/34 (35%) patients. The defects were mild in 5, moderate in 4 and severe in 3 cases. One child out of 12 children who used VGB less than one year (Group 1) had a mild VFD. Four of 9
17s (2013) S1 – S149
S49
patients (44%) using VGB up to 22–24 months and 7/13 patients (53%) using VGB more than 2 years (Group 3) had VFDs. Defects were mild (2), moderate (1) and severe (1) in the Group 2, and mild (2), moderate (3) and severe (2) in the Group 3. The mean cumulative doses were 155 g (Group 1), 808 g (Group 2) and 2547 g (Group 3), respectively. The patients with TS had more VFDs (6/9 patients) but their VGB treatment was also longer. The frequency of VFDs varied in different centers. Conclusions: The VFDs were found in the same frequency as reported in adults. The plasticity of an infant retina seems not to prevent from the damage. The risk/benefit ratio should always be carefully considered when using VGB. Treatment should be as short as possible.
PP7.7 - 1583 The effectiveness of a low-dose oral diazepam treatment to prevent recurrence of febrile seizures Park HJ, Kim SY, Choi SH. MBL Children’s Hospital, Eulji Medical University, Korea – [email protected] Purpose: Diazepam suppositories or oral diazepam have been used to prevent recurrence of febrile seizures (FS). But this strategy cause many side effects such as sleepiness, lethargy, irritability, and ataxia. This study aimed to investigate the optimum dose of diazepam to reduce the recurrence of FS and side effects in children who have had a febrile seizure attack. Methods: The subjects of this study included 528 children with FS who were admitted fto Eulji University Hospital from 2008 to 2011. The children divided into four groups according to the dose of diazepam: Group I, 121 patients, received no diazepam therapy, Group II, 129 patients, received oral diazepam in a single dose of 0.1 mg/kg after the febrile seizure, Group III, 127 patients, 0.2mg/Kg, and Group IV, 151 patients, 0.3 mg/kg, respectively. Results: Seizures recurred in 6 of 129 children (4.7%) in Group II, 1 of 127 (0.8%) in Group III, and none of 151 children in Group IV. For the 121 untreated patients, FS recurred in 20 children (16.5%). This study revealed a significant difference in the rate of recurrence of FS between children treated with diazepam and those who were not. And the recurrence rate was decreased by the increment of the dosage of diazepam. The adverse effects were observed in 19.9% of children with diazepam, 3.9% in Group II, 12.6% in Group III, and 39.7% in Group IV. The rate of adverse effects was also increased with the increment of dosage. Conclusion: An oral diazepam therapy will reduce the recurrence of FS during the same febrile illnesses. We think the optimum dose of diazepam is 0.1 mg/kg or 0.2 mg/kg rather than 0.3 mg/kg. However, the use of oral diazepam after a FS should be carefully considered with weighing the benefits and potential adverse effects.
PP7.8 - 1576 Successful desensitization of oxcarbazepine and ethosuximide after cutaneous adverse drug reactions and HLA genotype in Korea Lee BL, Yu H, Lee M, Lee J. Department of Pediatrics, Pusan Paik Hospital, Inje University College of Medicine, Korea – [email protected] Objective: Allergic reaction to specific antiepileptic drugs (AEDs) can occur in some patients and require a change of therapy. An alternative strategy is to desensitize the patients to the offending drug. This study aimed to investigate the usefulness and safety of desensitization to oxcarbazepine (OXC) and ethosuximide (ETX) in patients who had cutaneous adverse drug reactions. Methods: We enrolled 20 patients who had good initial response to OXC (n=19) or ETX (n=1), but who discontinued due to cutaneous adverse drug reactions. Although alternative AEDs were tried on our patients, their seizures were refractory. Therefore, desensitization to OXC was tried in 18 children with partial seizures
S50
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
and one child with paroxysmal kinesigenic dyskinesia (PKD), and to ETX was attempted in one child with atypical absence seizures. High-resolution human leukocyte antigen (HLA)-A, and -B genotyping was performed to investigate the association between specific HLA allele and OXC-induced cutaneous adverse drug reactions. Results: The median age at desensitization was 11.3±3.5 years (range 4.8–16.2 years) and the mean duration of follow-up was 16.2±8.7 months (range 5–37 months). Nineteen patients completed the desensitization protocol to a target dosage over 2–5 months. Five children developed mild itching and erythema during desensitization, but the symptoms disappeared after the next dose increment was withheld for a short period. We did not find specific HLA genotypes associated with OXC-induced cutaneous adverse drug reactions. The frequency of seizure or dyskinesia was reduced to less than baseline in 18 patients. At last follow-up, eight patients were seizure-free, five patients showed >90% reduction and the other four patients had >50% reduction. Conclusions: The desensitization protocol was well tolerated and safe without serious allergic reactions. When allergic reactions occur with OXC or ETX and there are no effective drugs, desensitization can be a useful alternative.
PP7.9 - 2061 Haematological parameters in children with epilepsy treated with levetiracetam monotherapy Dinopoulos A, Paschalidou M, Tsirouda M, Garoufi A, Zafiropoulou F, Attilakos A. 3rd department of Pediatrics, University of Athens, “Attikon” University Hospital, Greece – [email protected] Objectives: Levetiracetam (LEV), a newer broad spectrum antiepileptic agent, is used successfully as monotherapy for partial onset seizures, rolandic epilepsy and myoclonic epilepsy and appears to be well tolerated with mild adverse effects. However, in contrast with the older antiepileptic drugs which are well known to cause hematological changes, the effect of LEV is not yet sufficiently investigated. The aim of this study was to investigate prospectively the hematological effects of LEV in children with epilepsy. Material and methods: The study population consisted of 20 children (8 males, 12 females, aged 2 to 15 years old, mean age 6.5±4.16 years) with epilepsy treated with LEV monotherapy. None of the children were receiving any form of AED medication prior to LEV initiation. Complete blood count (CBC) was performed in all children, before and at 2 and 6 months of LEV monotherapy. Results: Lymphocyte absolute count was significantly decreased at 6 months (p=0.021) of LEV monotherapy. The rest of the white blood cells count as well as the red blood cells parameters and the platelets were not altered. Conclusions: LEV monotherapy may significantly decrease lymphocyte count at six months of treatment in children with epilepsy. This might indicate the need to monitor lymphocyte count and infection tendency in children receiving LEV. The depletion of lymphocytes, which is a primary component of the immune system could be associated with the higher incidence of infections reported in children receiving LEV. Further prospective studies are needed to investigate the effect of LEV in lymphocyte numbers and the possible association with the infection frequency reported in LEV patients.
17s (2013) S1 – S149
PP8. Learning disorders/Immunology Chair: Günter Bernert
PP8.0 - 1978 Rising prevalence of CVI in main stream education calls for a different approach Depourcq M, Vandamme AL, Bonamie E, Keppens K. De Kade, Spermalie, Bruges, Belgium – [email protected] Prevalence data indicate that CVI (Cerebral Visual Impairment) now is the leading cause of vision impairment in children. Better ability of the school support teams in dealing with CVI-related problems ensure that more children remain in main stream education. Whereas better general awareness for (presumption of) visual dysfunction leads to more referrals to CVI-clinics. Therefore we notice an increasing population of children with CVI in main stream education over the last five years. The presence of students with CVI nearing or in secondary education calls for a customized, specific, often multidisciplinary approach. Objectives: Better support of CVI students in main stream secondary education. Material and methods: Prevalence data of the home intervention team Accent, De Kade, Spermalie Bruges. For better understanding of the needs of CVI students, they are referred to our multidisciplinary team. The data of these investigations are collected in a retrospective study. Results: Between 2004 and 2008 only 2 students with CVI attended main stream secondary education and were supported by home intervention team Accent and/or the school support team Spermalie. Between 2009 and 2012 this amount increased to 12 students with CVI. We will give a detailed overview of their needs and concerns and of the typical problems they are confronted with. We will also provide information about the current approach and support. Conclusions: Students with CVI in main stream secondary schools demand a different approach and/or support package than children with CVI in primary schools.
PP8.1 - 1634 G.CVI.Tods, a novel diagnostic tool in the assessment of cerebral visual impairment in the young child Van Parijs K 1 , Vandeput A 1 , Peirens G 1,2 , Ortibus E 1,2 . 1 Centrum Ganspoel, Belgium, 2 University Hospitals Leuven, Department of Pediatric Neurology, Leuven, Belgium – [email protected] Objectives: Cerebral Visual Impairment (CVI), a neurological condition characterized by an impaired visual perception, has a large negative impact on global development. Early detection and early intervention leads to an improved quality of life. In children under 3 years and in those with a multiple handicap, diagnosis of CVI is largely based on observational and subjective methods, due to language or motor disabilities. Moreover, normative data for visual field size are lacking. Material and methods: Ganspoel, an institution for the care for visually impaired people, set out to construct a standardized battery for the assessment of visual perceptual skills in this age group. Flemish children of 18, 24 and 30 months with a normal global development and a normal refraction, performed the G.CVI.Tods. The battery consists of a different constellation of subtests depending on age: Visual recognition of o 3D situations (all) o 2D situations (line drawings (30m), colored images & photos (all)) of single objects (photos (18m), line drawings (24, 30m), black & white images & photos unconventional viewpoint (30m), colored images (all)) o simple objects (18m) Motion pursuit (all) Visual field assessment (all) Daily visual functioning (18m). Results: Sixty-four children were examined at 18 months, 67 at 24m and 77 at 30m. Sum scores of the visual recognition tasks and of the pursuit of motion task, the highest scores for every quadrant of the visual field
PP7.5 - 1768 Efficacy of long-term adjunctive zonisamide therapy in paediatric patients with partial epilepsy: results of an open-label extension study of a Phase III, randomised, double-blind, placebo-controlled trial Rosati A, Giorgi L, Bradshaw K, Guerrini R. Neuroscience Department, Children’s Hospital Anna Meyer-University of Florence, Florence, Italy – [email protected] Objectives: To assess the long-term efficacy of once-daily adjunctive zonisamide therapy in paediatric patients with partial epilepsy. Material and methods: An open-label extension study of a Phase III, double-blind, randomised, placebo-controlled, multicentre trial was conducted in patients (age 6–18 years) with partial epilepsy receiving one or two antiepileptic drugs (AEDs). Study began with a double-blind transition period (duration 2–11 weeks), during which patients already receiving zonisamide continued at same dose, while those previously receiving placebo switched to zonisamide, initiated at 1 mg/kg/day and up-titrated to a target of 8 mg/kg/day (maximum 500 mg/day). This was followed by an open-label period (duration 45–57 weeks), during which zonisamide dosing could be adjusted according to tolerability/response. Primary efficacy assessment was responder rate during open-label period (response defined as ≥50% seizure frequency reduction from baseline of initial trial). Secondary assessments included seizure freedom rate and reduction in 28-day seizure frequency (from baseline of original trial) during open-label period. Results: In total, 144 patients entered the extension study, of whom 72 had received placebo and 72 had received zonisamide during the initial trial; 99/144 (68.8%) patients completed the study. During open-label period, 81/144 (56.3%) patients were responders (95% confidence interval [CI], 47.7%, 64.5%). Results were similar for patients who initially received placebo (40/72; 55.6%; 95% CI, 43.4%, 67.3%) and zonisamide (41/72; 56.9%; 95% CI, 44.7%, 68.6%). Overall, 16/144 (11.1%) patients achieved seizure freedom during open-label period (95% CI, 6.5%, 17.4%); results being identical for patients initially receiving placebo and zonisamide (for both populations: 8/72; 11.1%; 95% CI, 4.9%, 20.7%). Seizure frequency reduction was maintained throughout the study; the median percentage decrease in seizure frequency being 65.9% during open-label period. Conclusions: The efficacy of adjunctive zonisamide in paediatric patients with partial epilepsy was maintained over a treatment period of >1 year.
PP7.6 - 687 Does vigabatrin treatment for infantile spasms cause visual field defects? An international multicenter study Riikonen R, Carmant L, Dorofeeva M, Hollody K, Krajnc B, Rener Primec Z, Szabo I, Wohlrab G, Sorri I. Kuopio, Finland – raili.riikonen@kolumbus.fi There exists little information how often the vigabatrin (VGB) treatment for infantile spasms (IS) causes irreversible visual field defects (VFDs). The aim of this study was to examine IS patients at school age for visual fields to see whether the VGB treatment in infancy had caused defects. Patients and Methods: This study included 34 children aged 11 (range 8 to 22 years). Six centers were involved in the study. Nine children had tuberous sclerosis (TS), two other symptomatic (mild brain malformations) and the remaining 23 cryptogenic aetiology for their spasms. Visual fields were examined by the Goldmann kinetic perimetry, by the static Humphrey or Octopus perimetry by experienced perimetrist. Visual fields were re-evaluated by the ophthalmologist (I.S). Results: We found typical VGB-attributed visual field defects altogether in 12/34 (35%) patients. The defects were mild in 5, moderate in 4 and severe in 3 cases. One child out of 12 children who used VGB less than one year (Group 1) had a mild VFD. Four of 9
17s (2013) S1 – S149
S49
patients (44%) using VGB up to 22–24 months and 7/13 patients (53%) using VGB more than 2 years (Group 3) had VFDs. Defects were mild (2), moderate (1) and severe (1) in the Group 2, and mild (2), moderate (3) and severe (2) in the Group 3. The mean cumulative doses were 155 g (Group 1), 808 g (Group 2) and 2547 g (Group 3), respectively. The patients with TS had more VFDs (6/9 patients) but their VGB treatment was also longer. The frequency of VFDs varied in different centers. Conclusions: The VFDs were found in the same frequency as reported in adults. The plasticity of an infant retina seems not to prevent from the damage. The risk/benefit ratio should always be carefully considered when using VGB. Treatment should be as short as possible.
PP7.7 - 1583 The effectiveness of a low-dose oral diazepam treatment to prevent recurrence of febrile seizures Park HJ, Kim SY, Choi SH. MBL Children’s Hospital, Eulji Medical University, Korea – [email protected] Purpose: Diazepam suppositories or oral diazepam have been used to prevent recurrence of febrile seizures (FS). But this strategy cause many side effects such as sleepiness, lethargy, irritability, and ataxia. This study aimed to investigate the optimum dose of diazepam to reduce the recurrence of FS and side effects in children who have had a febrile seizure attack. Methods: The subjects of this study included 528 children with FS who were admitted fto Eulji University Hospital from 2008 to 2011. The children divided into four groups according to the dose of diazepam: Group I, 121 patients, received no diazepam therapy, Group II, 129 patients, received oral diazepam in a single dose of 0.1 mg/kg after the febrile seizure, Group III, 127 patients, 0.2mg/Kg, and Group IV, 151 patients, 0.3 mg/kg, respectively. Results: Seizures recurred in 6 of 129 children (4.7%) in Group II, 1 of 127 (0.8%) in Group III, and none of 151 children in Group IV. For the 121 untreated patients, FS recurred in 20 children (16.5%). This study revealed a significant difference in the rate of recurrence of FS between children treated with diazepam and those who were not. And the recurrence rate was decreased by the increment of the dosage of diazepam. The adverse effects were observed in 19.9% of children with diazepam, 3.9% in Group II, 12.6% in Group III, and 39.7% in Group IV. The rate of adverse effects was also increased with the increment of dosage. Conclusion: An oral diazepam therapy will reduce the recurrence of FS during the same febrile illnesses. We think the optimum dose of diazepam is 0.1 mg/kg or 0.2 mg/kg rather than 0.3 mg/kg. However, the use of oral diazepam after a FS should be carefully considered with weighing the benefits and potential adverse effects.
PP7.8 - 1576 Successful desensitization of oxcarbazepine and ethosuximide after cutaneous adverse drug reactions and HLA genotype in Korea Lee BL, Yu H, Lee M, Lee J. Department of Pediatrics, Pusan Paik Hospital, Inje University College of Medicine, Korea – [email protected] Objective: Allergic reaction to specific antiepileptic drugs (AEDs) can occur in some patients and require a change of therapy. An alternative strategy is to desensitize the patients to the offending drug. This study aimed to investigate the usefulness and safety of desensitization to oxcarbazepine (OXC) and ethosuximide (ETX) in patients who had cutaneous adverse drug reactions. Methods: We enrolled 20 patients who had good initial response to OXC (n=19) or ETX (n=1), but who discontinued due to cutaneous adverse drug reactions. Although alternative AEDs were tried on our patients, their seizures were refractory. Therefore, desensitization to OXC was tried in 18 children with partial seizures
S50
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
and one child with paroxysmal kinesigenic dyskinesia (PKD), and to ETX was attempted in one child with atypical absence seizures. High-resolution human leukocyte antigen (HLA)-A, and -B genotyping was performed to investigate the association between specific HLA allele and OXC-induced cutaneous adverse drug reactions. Results: The median age at desensitization was 11.3±3.5 years (range 4.8–16.2 years) and the mean duration of follow-up was 16.2±8.7 months (range 5–37 months). Nineteen patients completed the desensitization protocol to a target dosage over 2–5 months. Five children developed mild itching and erythema during desensitization, but the symptoms disappeared after the next dose increment was withheld for a short period. We did not find specific HLA genotypes associated with OXC-induced cutaneous adverse drug reactions. The frequency of seizure or dyskinesia was reduced to less than baseline in 18 patients. At last follow-up, eight patients were seizure-free, five patients showed >90% reduction and the other four patients had >50% reduction. Conclusions: The desensitization protocol was well tolerated and safe without serious allergic reactions. When allergic reactions occur with OXC or ETX and there are no effective drugs, desensitization can be a useful alternative.
PP7.9 - 2061 Haematological parameters in children with epilepsy treated with levetiracetam monotherapy Dinopoulos A, Paschalidou M, Tsirouda M, Garoufi A, Zafiropoulou F, Attilakos A. 3rd department of Pediatrics, University of Athens, “Attikon” University Hospital, Greece – [email protected] Objectives: Levetiracetam (LEV), a newer broad spectrum antiepileptic agent, is used successfully as monotherapy for partial onset seizures, rolandic epilepsy and myoclonic epilepsy and appears to be well tolerated with mild adverse effects. However, in contrast with the older antiepileptic drugs which are well known to cause hematological changes, the effect of LEV is not yet sufficiently investigated. The aim of this study was to investigate prospectively the hematological effects of LEV in children with epilepsy. Material and methods: The study population consisted of 20 children (8 males, 12 females, aged 2 to 15 years old, mean age 6.5±4.16 years) with epilepsy treated with LEV monotherapy. None of the children were receiving any form of AED medication prior to LEV initiation. Complete blood count (CBC) was performed in all children, before and at 2 and 6 months of LEV monotherapy. Results: Lymphocyte absolute count was significantly decreased at 6 months (p=0.021) of LEV monotherapy. The rest of the white blood cells count as well as the red blood cells parameters and the platelets were not altered. Conclusions: LEV monotherapy may significantly decrease lymphocyte count at six months of treatment in children with epilepsy. This might indicate the need to monitor lymphocyte count and infection tendency in children receiving LEV. The depletion of lymphocytes, which is a primary component of the immune system could be associated with the higher incidence of infections reported in children receiving LEV. Further prospective studies are needed to investigate the effect of LEV in lymphocyte numbers and the possible association with the infection frequency reported in LEV patients.
17s (2013) S1 – S149
PP8. Learning disorders/Immunology Chair: Günter Bernert
PP8.0 - 1978 Rising prevalence of CVI in main stream education calls for a different approach Depourcq M, Vandamme AL, Bonamie E, Keppens K. De Kade, Spermalie, Bruges, Belgium – [email protected] Prevalence data indicate that CVI (Cerebral Visual Impairment) now is the leading cause of vision impairment in children. Better ability of the school support teams in dealing with CVI-related problems ensure that more children remain in main stream education. Whereas better general awareness for (presumption of) visual dysfunction leads to more referrals to CVI-clinics. Therefore we notice an increasing population of children with CVI in main stream education over the last five years. The presence of students with CVI nearing or in secondary education calls for a customized, specific, often multidisciplinary approach. Objectives: Better support of CVI students in main stream secondary education. Material and methods: Prevalence data of the home intervention team Accent, De Kade, Spermalie Bruges. For better understanding of the needs of CVI students, they are referred to our multidisciplinary team. The data of these investigations are collected in a retrospective study. Results: Between 2004 and 2008 only 2 students with CVI attended main stream secondary education and were supported by home intervention team Accent and/or the school support team Spermalie. Between 2009 and 2012 this amount increased to 12 students with CVI. We will give a detailed overview of their needs and concerns and of the typical problems they are confronted with. We will also provide information about the current approach and support. Conclusions: Students with CVI in main stream secondary schools demand a different approach and/or support package than children with CVI in primary schools.
PP8.1 - 1634 G.CVI.Tods, a novel diagnostic tool in the assessment of cerebral visual impairment in the young child Van Parijs K 1 , Vandeput A 1 , Peirens G 1,2 , Ortibus E 1,2 . 1 Centrum Ganspoel, Belgium, 2 University Hospitals Leuven, Department of Pediatric Neurology, Leuven, Belgium – [email protected] Objectives: Cerebral Visual Impairment (CVI), a neurological condition characterized by an impaired visual perception, has a large negative impact on global development. Early detection and early intervention leads to an improved quality of life. In children under 3 years and in those with a multiple handicap, diagnosis of CVI is largely based on observational and subjective methods, due to language or motor disabilities. Moreover, normative data for visual field size are lacking. Material and methods: Ganspoel, an institution for the care for visually impaired people, set out to construct a standardized battery for the assessment of visual perceptual skills in this age group. Flemish children of 18, 24 and 30 months with a normal global development and a normal refraction, performed the G.CVI.Tods. The battery consists of a different constellation of subtests depending on age: Visual recognition of o 3D situations (all) o 2D situations (line drawings (30m), colored images & photos (all)) of single objects (photos (18m), line drawings (24, 30m), black & white images & photos unconventional viewpoint (30m), colored images (all)) o simple objects (18m) Motion pursuit (all) Visual field assessment (all) Daily visual functioning (18m). Results: Sixty-four children were examined at 18 months, 67 at 24m and 77 at 30m. Sum scores of the visual recognition tasks and of the pursuit of motion task, the highest scores for every quadrant of the visual field