- Email: [email protected]
Southern electroencephalographic society
ELECTROENCEPHALOGRAPHYAND CLINICAL NEUROPHYSIOLOGY
SOCIETY
579
PROCEEDINGS
SOUTHERN ELECTROENCEPI-:ALOGRAPHIC SOCIETY Galveston, Texas, November 2924, 196:
Secretary-Treasurer: L. F. STEWART, M . D . Departrm,nt of Neurology and Psychiatry, University of Virginia School of Medicine, Charlottesville, Virginia (U.S.A.)
I. Steady potential, the direct cortical response and the epileptic focus. - - S. Wilson and R. Schmidt (Gainesville, Fla.). The purpose of this research is to study the properties of direct cortical responses (IM~R) in an experimentally created epileptogenie focus. Subjects consisted of 35 adult cats in which a 0.5 inch area in the posterior portion of the right suprasylvian 8yrus was frozen with ethyl chloride spray through the intact dura. At varying intervals up to 2 months the operated area as well as the contralateral area was reopened. Electrocorticograms were then performed to determine the area of spike activity. The critical calomel electrode was placed on the area of spike activity and the reference electrode on the frontal bone. Stimuli of 0.01 msec duration and 6 to 15 V, at frequencies of 1, 6 and 20/,s~o were administered within 0.5 nun of the critical calomel electrode. Sub:~equent events were recorded by means of a d.c, amplifier, oscillcscope and camera. Results revealed that there was a marked diminution in the amplitude of D O t in the area of spike activity. There is little or no negative shift in the standing potential upon repetitive ~timulation. Failure to confirm the negative shift observed in other forms of epileptic foot may indicate maximal depolarization of dendrites which are therefore capable of only limited additional responses. 2. Photo-melrazol activation in the dlngnmis of psyctmmotor seizures. - - H. Hlgnmn and G. Ferrba (New Orleans, La.). Although the diagnostic implications of a low convulsive threshold tophoto.metrazol stimulation have not been well defined, the procedure is clinically useful when it produces focal EEG abnormalities. This report is of four cases of episodic behavioral abnormalities which posed difficulty in diagnosis because the waking, sleeping, hyperventilation, and photie stimulation records were normal. Using a photo.metrazol technique, seizures were induced which reproduced the behavioral pattern described in the clinical history. These were accompanied by confirmatory focal EEG abnormalities.
3. Tourniquet block in peripheral nerve. - - R. Weaver (Gainesville, Fla.). The paresthesias, areflexia, paralysis and anesthesia which follow the prolonged application cf a tourniquet to a limb have usually been ascribed to ischemia of nerve although occasionally direct pressure on nerve has been implicated. Tourniquets were applied to the lower extremities of anesthetized cats and the subsequent alterations of action potentials in the saphenous nerve recorded oscillographically. The nerve block produced by a pneumatic cuff inflated to 300 nun of mercury was similar to that produced by ischemia alone. Delta (small myelinated) fibers blocked first, quickly followed by beta (large myelinated) fibers. C fibers were little affected at the time of complete myelin~ted fiber block. A tit~htnarrow tourni. quet produced a different, partially irreversible nerve block affecting nerve fibers in order of decreasing diam. eter. These two types of nerve block were reproduced in isolated nerves by hypoxia and by pressure. It is concluded that a ~ourniquet may block peripheral nerve by either or both of two methods: ischemia, or deforming pressure, The nerve blink produced by a blood pressure cuff is of the isohemic type. 4. Effect of experimentally manipulating an EEG stage of sleep. - - H, Apew, Jr., W, Webb and R. William (Galnssville, Fla.). A study of the effect of depriving subjects of the delta dominant phase of sleep (Dement-Kleitman Stage IV) was carried out on five healthy male medical students. Subjects were run on a schedule of four nights of baseline sleep, two Stage 4 deprivation nights followed by a recovery night. Stage 4 deprivation was accomplished by sounding a tone as soon as it appeared the subject was in Stage 3, which past studies show heralds Stage 4. The results show that individuals may be deprived of Stage 4 sleep without a deprivation of the quantitative amount of sleep, i.e., they may be "moved" from Stage 4 into other stages of sleep without awakening. Second, the "movement" of sleep, in this study, did not occur into any other stage of sleep. Third, a deprivation of Stage 4 sleep results in a significant increase in this type of sleep during a recovery night.
Electroeneeph. ella. Neurophysiol,, 1964, 17:579-581
SOCIETY PROCEEDINGS The significant increase in Stage 4 sleep after deprivation would suggest that Stage 4 sleep deprivation results in a requiren~t for sleep associated with this type of EEG activity. (Full paper in Electroenceph. clan. Neurophysioi., 1964, 17: 68-70). 5. ~he effect of delm~ive ~ on EEG response to anditoryfmndatlondur~sleep.--W. Zung and W. WiI~ ~ , N.C.). The pathological sleep state of individuals with depressive disorders has never been fully investigated, in a previous study, the authors demonstrated the pattern of EEG responses to auditory stimulation during sleep of normal control subjects, at the various stages of sleep. The possible relationships of auditory stimulation as a factor producing the disturbed state as manifest in the depressive disorder were postulated. The present study deals with the EEG responses to auditory stimulation during sleep of depressed subjects who were hospitalized patients. The diagnosis of the depressive disorder was clinically based upon the presence of a pervasive depressed affect and its physiological and psychological concomitants. The previously described techniques were used to study the EEG responses to auditory stimulation during sleep. This consisted of continuous sleep BEG recordinp, and the use of pro.taped sounds which were played at the various stages of sleep. This study was carried out on depre~c,sed patients, both before and after treatment. Results of these studies are as follows: It was found that in a comparison of the responses to familiar versus unfamiliar sounds, the depressed patients reacted in the ~me manner as a normal control group, and made no distinction as to the content of the sound at any stage of sleep. However, in ~ comparison of the responses to auditory stimulation by the depressed patient group, before treatment, with the responsesmade by the normal control group, the depressed patient group responded all,gently in a statistically significant m&nner at all stages of sleep,exhibiting a heightened arousal response.Further, responses to auditory stimulation by these same patients after treatment of their illnesses indicated no significant differences in their responses when compared to the normal control group, at any stage of sleep. The results of this study were discussed in terms of the usual concepts of sleep disturbance in depressive disorders, and the neurophysiological implications of the findings. 6. A quantitative EEG elamiflcatlan, - - M, Blanton and S. Little (Bimlagham Ala.). Until October 31, 1959, the EEG Laboratories in Birmingham, Alabama followed the generally accepted method of interpreting or classifying EEGs a~ . Normal . . . , "Borderline", and "Abnormal". Thereafter the classifies. flea system was expanded by subdividing each of the main categories into three subgroups. However, this system was still based on intuitive ngthods of classification directly related to the experience and skill of elcctroenccphalographers. Such standards of interpretation arc difficult to
communicate to trainees in the field and permit a rather wide variance in the classification of the same race_rd by different e!ectrceneephalographers. This presentation is a preliminary report of an attempt to develop objective measurable standards which can serve as a reference source for the nine-point system of classification. Electroencephalo~ams were selected which showed a particular type of abnormality. Aclassification number was assigned on the basis of this particular finding, disregarding all other changes in the record. The characteristics of the abnormality were then manually analyzed as to average amplitude, percent.time present, paroxysmal occurrence, etc. These measur~tents were then correlated with the intuitively assigned classification number using graphical and other mathematical methods. Illustrations will be shown of the relationships between the various measurable factors and the classification numbers assigned for delta activity and for the fourteen and six per second dysrhythmia. An almost linear relationship appears to exist between the functions of the measurements of delta activity and the classification number assigned, indicating tha~ the intuitive method of classification was reasonably accurate for this particular type of activity. In contrast, the intuitive grading of the records with the fourteen and six per second dysrhythmia appears to have been arbitrary and almost capricious, and a need for more objective standards for grading this type of change is clearly needed. The study will be continued with the aim of developing measurable reference sta,dards for each of the principal types of EEO abnormality. ?, EEG patterns correlated with ventvleular size. ~ M. ,lurko, O. Andy and S. Nelwn (Jackson, MIn.). Previous observations revealed relatively larger v©ntricles and more frequent EEG abnormalities in patients with movement disorders, than in a control group of patients. In view of these observations an attempt was made to correlate the ventricular size with the degree of EEG abnormality. Twenty.four white patients with movements disorders were studied. Their average age was 53 years (ranp 16-71), seven females and seventeenmales. The diagnoses were: 21 Parkinson's syndrome, one cerebral palsy, one Huntington's chorea and one dystonia musculorum deformans. The EEGs were done without sedation. Unipolar and bipolar EEGs were run in the awake patient and no seda. tion utilized. The EEG tracings ~ r e divided into the following four groups: (I) normal, (2) dysrhythmic, (3) thcta, and (4) theta-delta. The dysrhythmic being the least and theta-delta the most abnormal. The width of the third ventricle was measured from pneumocncephalograms. The PA view of the heed was used following the injection of 10-20 ml of air into the lumbar subarachnoid space.
Results The older patients with movement disorders tended to have more theta and theta-delta BEG patterns. Patients
Eleetroenceph. clan. Neurophysiol., 1964, 17:579-581
SOUTHERN EEG SOCIETY with slow EEG patterns displayed relatively larger ventricles. However, ventricular size did not appear to increase with age. it should also be noted that patients with theta-clelta activity tended to have disease of relatively short duration. Among the patients with dysrhythmic patterns, rigidity and tremor or tremor alone were manifest, those with slower patterns primarily had tremor. & Varieties of epileptic diseharges in centreueeldmlie epilg~y. ~ W. Wilson, lB. Harris, HI and D. Giantureo (Dmlm~ N.C.). A careful review of the literature reveals that little has been written in regard to the variability of centrencephalic epileptic discharges in individual patients. As well, only a few authors have commented on the transients occurring as abortive epileptic discharges. As the,~elatter abnormalities might possibly be the only findings in some patients examined in the EEG laboratories, it was thought that a study of these and the varieties of epileptic discharge occurring in this form of epilepsy was indicated. All of the EEGs obtained on 178 patients with centrencephalic epilepsy were examined. Only those patients who had at least one record with some form of classical petit real, myoclonic, grand real or petit real variant forms of eentreneephalie discharge as described by Gibbs were included. The clinical charts of each of these patients was examined to confirm the diagnosis and to as~ ~'rtain the varieties of clinical seizures occurring. Each EEG was examined and the varieties of epileptic discharge recorded. Transients occurring were classified and found to fall into
six types. It was ascertained that most patients with centrencephalic epilepsy have more than one type of discharge. That there is little correlation between seizure type and the type of epileptic discharge. That a variety of transients occur frequently in the EEGs of thc,se patients. The occurrcnee of these transients as the only finding in the EEGs of patients with epilepsy can be used to indicate the need for more extensive investigation whe,i more classical discharge is not seen. 9. The occurrence of 14 and 6Isle positive spike activity u n d a t e d with head injury. A seudy of ten cases. - E, Ogle and W. Ogle (Memphis, Tenn.). 14 and 6/see positive spike activity in the electroencephalogram is now a well recognized finding. It has been
58 !
thoroughly doeumf~nted and reported in many excellent reviews and the many conditions in which this activity is present have been reviewed at great length in literature. The purpose of this paper is to discuss the occurrence of 14 and 6 positive spike activity following head trauma. Ten cases from a private neurosurgical clinic have been followed with serial electroencephalograms. Th.;s specific activity, as found in these cases, is correlated with the clinical course of the patient and the subsequent neurosurgieal follow-up. While the number of cases is small, it is felt that observations drawn during the course of the follow-up, which ranges from 3 months to 3 years, are valid, considering the close clinical correlation that was obtained. 10.Hypsan'hytlunia. - - C. Erwin and W. Wilson (Durham, N.C.). Although the entity of hypsarrhythmia is wct~ known, the total number of cases reported in the literature is small. It therefore seems desirable to continue to add to the literature relative to this syndrome. Of particular importance are observations on possible etiologic factors as well as effects of treatment. A number of reports have indicated that ACTH and adrenal steroids have a beneficial effect on the severity of EEG abnormality and the frequency of seizures: However, in most instances mental deficiency still occurs as a concomitant of this syndrome. Twentyseven cases have been observed in the EEG Laboratory at the Duke Medical Center in the last 3 years, Of these, thirteen have received ACTH therapy over periods that would be considered an adequate trial and in doses comparable to those used by other investigators. Etiologic factors were definitely determined in nine patients. On examination only one of 27 ,~atients was found to be clearly normal in development. All but one of the thirteen patients treated with ACTH were considered to b¢ significantly retarded at the onset of treatment. Although some improvement was occasionally s~n, none achieved normal
developmental levels during the period of observation which averaged 10.6 months. EEG chanl~ occurring in this series were interesting in that with theraw two of these thirteen diffusely abnormal records became either unilaterally or focally abnormal and nine had a reduction of 50% or more in the frequency of epileptic discharge, concomitant with improvement in the background activity. The findings reported in this series are similar to other published reports,
Electroenceph. clin. Neurophy.Tiol., 1964, 17:579-581
SOCIETY
579
PROCEEDINGS
SOUTHERN ELECTROENCEPI-:ALOGRAPHIC SOCIETY Galveston, Texas, November 2924, 196:
Secretary-Treasurer: L. F. STEWART, M . D . Departrm,nt of Neurology and Psychiatry, University of Virginia School of Medicine, Charlottesville, Virginia (U.S.A.)
I. Steady potential, the direct cortical response and the epileptic focus. - - S. Wilson and R. Schmidt (Gainesville, Fla.). The purpose of this research is to study the properties of direct cortical responses (IM~R) in an experimentally created epileptogenie focus. Subjects consisted of 35 adult cats in which a 0.5 inch area in the posterior portion of the right suprasylvian 8yrus was frozen with ethyl chloride spray through the intact dura. At varying intervals up to 2 months the operated area as well as the contralateral area was reopened. Electrocorticograms were then performed to determine the area of spike activity. The critical calomel electrode was placed on the area of spike activity and the reference electrode on the frontal bone. Stimuli of 0.01 msec duration and 6 to 15 V, at frequencies of 1, 6 and 20/,s~o were administered within 0.5 nun of the critical calomel electrode. Sub:~equent events were recorded by means of a d.c, amplifier, oscillcscope and camera. Results revealed that there was a marked diminution in the amplitude of D O t in the area of spike activity. There is little or no negative shift in the standing potential upon repetitive ~timulation. Failure to confirm the negative shift observed in other forms of epileptic foot may indicate maximal depolarization of dendrites which are therefore capable of only limited additional responses. 2. Photo-melrazol activation in the dlngnmis of psyctmmotor seizures. - - H. Hlgnmn and G. Ferrba (New Orleans, La.). Although the diagnostic implications of a low convulsive threshold tophoto.metrazol stimulation have not been well defined, the procedure is clinically useful when it produces focal EEG abnormalities. This report is of four cases of episodic behavioral abnormalities which posed difficulty in diagnosis because the waking, sleeping, hyperventilation, and photie stimulation records were normal. Using a photo.metrazol technique, seizures were induced which reproduced the behavioral pattern described in the clinical history. These were accompanied by confirmatory focal EEG abnormalities.
3. Tourniquet block in peripheral nerve. - - R. Weaver (Gainesville, Fla.). The paresthesias, areflexia, paralysis and anesthesia which follow the prolonged application cf a tourniquet to a limb have usually been ascribed to ischemia of nerve although occasionally direct pressure on nerve has been implicated. Tourniquets were applied to the lower extremities of anesthetized cats and the subsequent alterations of action potentials in the saphenous nerve recorded oscillographically. The nerve block produced by a pneumatic cuff inflated to 300 nun of mercury was similar to that produced by ischemia alone. Delta (small myelinated) fibers blocked first, quickly followed by beta (large myelinated) fibers. C fibers were little affected at the time of complete myelin~ted fiber block. A tit~htnarrow tourni. quet produced a different, partially irreversible nerve block affecting nerve fibers in order of decreasing diam. eter. These two types of nerve block were reproduced in isolated nerves by hypoxia and by pressure. It is concluded that a ~ourniquet may block peripheral nerve by either or both of two methods: ischemia, or deforming pressure, The nerve blink produced by a blood pressure cuff is of the isohemic type. 4. Effect of experimentally manipulating an EEG stage of sleep. - - H, Apew, Jr., W, Webb and R. William (Galnssville, Fla.). A study of the effect of depriving subjects of the delta dominant phase of sleep (Dement-Kleitman Stage IV) was carried out on five healthy male medical students. Subjects were run on a schedule of four nights of baseline sleep, two Stage 4 deprivation nights followed by a recovery night. Stage 4 deprivation was accomplished by sounding a tone as soon as it appeared the subject was in Stage 3, which past studies show heralds Stage 4. The results show that individuals may be deprived of Stage 4 sleep without a deprivation of the quantitative amount of sleep, i.e., they may be "moved" from Stage 4 into other stages of sleep without awakening. Second, the "movement" of sleep, in this study, did not occur into any other stage of sleep. Third, a deprivation of Stage 4 sleep results in a significant increase in this type of sleep during a recovery night.
Electroeneeph. ella. Neurophysiol,, 1964, 17:579-581
SOCIETY PROCEEDINGS The significant increase in Stage 4 sleep after deprivation would suggest that Stage 4 sleep deprivation results in a requiren~t for sleep associated with this type of EEG activity. (Full paper in Electroenceph. clan. Neurophysioi., 1964, 17: 68-70). 5. ~he effect of delm~ive ~ on EEG response to anditoryfmndatlondur~sleep.--W. Zung and W. WiI~ ~ , N.C.). The pathological sleep state of individuals with depressive disorders has never been fully investigated, in a previous study, the authors demonstrated the pattern of EEG responses to auditory stimulation during sleep of normal control subjects, at the various stages of sleep. The possible relationships of auditory stimulation as a factor producing the disturbed state as manifest in the depressive disorder were postulated. The present study deals with the EEG responses to auditory stimulation during sleep of depressed subjects who were hospitalized patients. The diagnosis of the depressive disorder was clinically based upon the presence of a pervasive depressed affect and its physiological and psychological concomitants. The previously described techniques were used to study the EEG responses to auditory stimulation during sleep. This consisted of continuous sleep BEG recordinp, and the use of pro.taped sounds which were played at the various stages of sleep. This study was carried out on depre~c,sed patients, both before and after treatment. Results of these studies are as follows: It was found that in a comparison of the responses to familiar versus unfamiliar sounds, the depressed patients reacted in the ~me manner as a normal control group, and made no distinction as to the content of the sound at any stage of sleep. However, in ~ comparison of the responses to auditory stimulation by the depressed patient group, before treatment, with the responsesmade by the normal control group, the depressed patient group responded all,gently in a statistically significant m&nner at all stages of sleep,exhibiting a heightened arousal response.Further, responses to auditory stimulation by these same patients after treatment of their illnesses indicated no significant differences in their responses when compared to the normal control group, at any stage of sleep. The results of this study were discussed in terms of the usual concepts of sleep disturbance in depressive disorders, and the neurophysiological implications of the findings. 6. A quantitative EEG elamiflcatlan, - - M, Blanton and S. Little (Bimlagham Ala.). Until October 31, 1959, the EEG Laboratories in Birmingham, Alabama followed the generally accepted method of interpreting or classifying EEGs a~ . Normal . . . , "Borderline", and "Abnormal". Thereafter the classifies. flea system was expanded by subdividing each of the main categories into three subgroups. However, this system was still based on intuitive ngthods of classification directly related to the experience and skill of elcctroenccphalographers. Such standards of interpretation arc difficult to
communicate to trainees in the field and permit a rather wide variance in the classification of the same race_rd by different e!ectrceneephalographers. This presentation is a preliminary report of an attempt to develop objective measurable standards which can serve as a reference source for the nine-point system of classification. Electroencephalo~ams were selected which showed a particular type of abnormality. Aclassification number was assigned on the basis of this particular finding, disregarding all other changes in the record. The characteristics of the abnormality were then manually analyzed as to average amplitude, percent.time present, paroxysmal occurrence, etc. These measur~tents were then correlated with the intuitively assigned classification number using graphical and other mathematical methods. Illustrations will be shown of the relationships between the various measurable factors and the classification numbers assigned for delta activity and for the fourteen and six per second dysrhythmia. An almost linear relationship appears to exist between the functions of the measurements of delta activity and the classification number assigned, indicating tha~ the intuitive method of classification was reasonably accurate for this particular type of activity. In contrast, the intuitive grading of the records with the fourteen and six per second dysrhythmia appears to have been arbitrary and almost capricious, and a need for more objective standards for grading this type of change is clearly needed. The study will be continued with the aim of developing measurable reference sta,dards for each of the principal types of EEO abnormality. ?, EEG patterns correlated with ventvleular size. ~ M. ,lurko, O. Andy and S. Nelwn (Jackson, MIn.). Previous observations revealed relatively larger v©ntricles and more frequent EEG abnormalities in patients with movement disorders, than in a control group of patients. In view of these observations an attempt was made to correlate the ventricular size with the degree of EEG abnormality. Twenty.four white patients with movements disorders were studied. Their average age was 53 years (ranp 16-71), seven females and seventeenmales. The diagnoses were: 21 Parkinson's syndrome, one cerebral palsy, one Huntington's chorea and one dystonia musculorum deformans. The EEGs were done without sedation. Unipolar and bipolar EEGs were run in the awake patient and no seda. tion utilized. The EEG tracings ~ r e divided into the following four groups: (I) normal, (2) dysrhythmic, (3) thcta, and (4) theta-delta. The dysrhythmic being the least and theta-delta the most abnormal. The width of the third ventricle was measured from pneumocncephalograms. The PA view of the heed was used following the injection of 10-20 ml of air into the lumbar subarachnoid space.
Results The older patients with movement disorders tended to have more theta and theta-delta BEG patterns. Patients
Eleetroenceph. clan. Neurophysiol., 1964, 17:579-581
SOUTHERN EEG SOCIETY with slow EEG patterns displayed relatively larger ventricles. However, ventricular size did not appear to increase with age. it should also be noted that patients with theta-clelta activity tended to have disease of relatively short duration. Among the patients with dysrhythmic patterns, rigidity and tremor or tremor alone were manifest, those with slower patterns primarily had tremor. & Varieties of epileptic diseharges in centreueeldmlie epilg~y. ~ W. Wilson, lB. Harris, HI and D. Giantureo (Dmlm~ N.C.). A careful review of the literature reveals that little has been written in regard to the variability of centrencephalic epileptic discharges in individual patients. As well, only a few authors have commented on the transients occurring as abortive epileptic discharges. As the,~elatter abnormalities might possibly be the only findings in some patients examined in the EEG laboratories, it was thought that a study of these and the varieties of epileptic discharge occurring in this form of epilepsy was indicated. All of the EEGs obtained on 178 patients with centrencephalic epilepsy were examined. Only those patients who had at least one record with some form of classical petit real, myoclonic, grand real or petit real variant forms of eentreneephalie discharge as described by Gibbs were included. The clinical charts of each of these patients was examined to confirm the diagnosis and to as~ ~'rtain the varieties of clinical seizures occurring. Each EEG was examined and the varieties of epileptic discharge recorded. Transients occurring were classified and found to fall into
six types. It was ascertained that most patients with centrencephalic epilepsy have more than one type of discharge. That there is little correlation between seizure type and the type of epileptic discharge. That a variety of transients occur frequently in the EEGs of thc,se patients. The occurrcnee of these transients as the only finding in the EEGs of patients with epilepsy can be used to indicate the need for more extensive investigation whe,i more classical discharge is not seen. 9. The occurrence of 14 and 6Isle positive spike activity u n d a t e d with head injury. A seudy of ten cases. - E, Ogle and W. Ogle (Memphis, Tenn.). 14 and 6/see positive spike activity in the electroencephalogram is now a well recognized finding. It has been
58 !
thoroughly doeumf~nted and reported in many excellent reviews and the many conditions in which this activity is present have been reviewed at great length in literature. The purpose of this paper is to discuss the occurrence of 14 and 6 positive spike activity following head trauma. Ten cases from a private neurosurgical clinic have been followed with serial electroencephalograms. Th.;s specific activity, as found in these cases, is correlated with the clinical course of the patient and the subsequent neurosurgieal follow-up. While the number of cases is small, it is felt that observations drawn during the course of the follow-up, which ranges from 3 months to 3 years, are valid, considering the close clinical correlation that was obtained. 10.Hypsan'hytlunia. - - C. Erwin and W. Wilson (Durham, N.C.). Although the entity of hypsarrhythmia is wct~ known, the total number of cases reported in the literature is small. It therefore seems desirable to continue to add to the literature relative to this syndrome. Of particular importance are observations on possible etiologic factors as well as effects of treatment. A number of reports have indicated that ACTH and adrenal steroids have a beneficial effect on the severity of EEG abnormality and the frequency of seizures: However, in most instances mental deficiency still occurs as a concomitant of this syndrome. Twentyseven cases have been observed in the EEG Laboratory at the Duke Medical Center in the last 3 years, Of these, thirteen have received ACTH therapy over periods that would be considered an adequate trial and in doses comparable to those used by other investigators. Etiologic factors were definitely determined in nine patients. On examination only one of 27 ,~atients was found to be clearly normal in development. All but one of the thirteen patients treated with ACTH were considered to b¢ significantly retarded at the onset of treatment. Although some improvement was occasionally s~n, none achieved normal
developmental levels during the period of observation which averaged 10.6 months. EEG chanl~ occurring in this series were interesting in that with theraw two of these thirteen diffusely abnormal records became either unilaterally or focally abnormal and nine had a reduction of 50% or more in the frequency of epileptic discharge, concomitant with improvement in the background activity. The findings reported in this series are similar to other published reports,
Electroenceph. clin. Neurophy.Tiol., 1964, 17:579-581