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Premature infants who have suffered electrographically confirmed seizures may have a higher risk of abnormal development than full-term infants who have suffered electrographically confirmed seizures. Electrographically confirmed seizures are those that occurred during electroencephalography, a method used to record the electrical activity of the brain. Among 92 newborn infants who suffered electrographically confirmed seizures, 62 were born prematurely and 30 were born full-term. Fifty-eight percent of the premature infants died, compared with 30% of the full-term infants. Ninety percent of the preterm infants developed brain lesions, compared to 86% of the full-term infants. Among the 46 surviving infants, 25% of the preterm infants exhibited normal development at the average age of six-and-a-half years, compared with 60% of the full-term infants. The occurrence of developmental problems or epilepsy was approximately the same among surviving children in both groups., Electrographically confirmed seizures in preterm and term neonates were compared with respect to clinical correlates, incidence, associated brain lesions, and risk for neurologic sequelae. Over a 4-year period, 92 neonates from a neonatal intensive care unit population of 4020 admissions at a large obstetric hospital with 40845 livebirths had electrographically confirmed seizures. Sixty-two neonates were preterm and 30 were full-term for gestational age. Chi-square calculations were used to compare the two groups. While the incidence of seizures for all neonates admitted to a neonatal intensive care unit was 2.3%, outborn neonates were more likely to have seizures than inborn neonates. Preterm neonates of [less than or equal to]30 weeks gestational age had a seizure frequency of 3.9%, which was significantly higher than that of older preterm neonates and full-term neonates. Clinical criteria contemporaneous with electrographic seizures were noted in only 28 (45%) of 62 preterm, and 16 (53%) of 30 full-term neonates. Subtle seizures coincident with electrographically confirmed seizures were the most predominant clinical type for both term and preterm neonates (71% and 68%, respectively). The distribution of clonic, myoclonic, and tonic seizures was also similar for both groups. Autonomic signs coincident with electrographically confirmed seizures (ie, blood pressure, heart rate, oxygenation, respiration changes) were more frequently observed in preterm than full-term neonates with subtle seizures; 7 (37%) of 19 compared with 1 (6%) of 16. Electrical seizures without clinical correlates were noted more frequently than electroclinical seizures for both populations. Fifteen (54%) of 28 of the preterm coincident group and 10 (63%) of 16 of the full-term group had isolated electrographic seizures without clinical seizures on the same or other records, in addition to exhibiting electroclinical seizures. More preterm neonates had a later onset of seizures (>48 hours of life) than term neonates (53% vs 13%, respectively). Ischemic brain lesions were noted in 23 (77%) of 30 of full-term compared with 24 (39%) of 62 preterm neonates. Intraventricular hemorrhage with ventriculomegaly or intraparenchymal involvement was seen in 26 (45%) of 72 preterm neonates compared with 1 (3%) of 30 full-term neonates. Mortality was greater in the preterm than in the term populations, 36 (58%) of 52, compared with 10 (30%) of 30, and a normal outcome was documented in 9 (25%) of 36

Cases have been reported of seizures and other neurological events that occurred in children shortly after immunization with the diphtheria-tetanus-pertussis (DTP) vaccine. It is not clear whether the DTP vaccine caused these events, and little research has been done to investigate the subject. A large group of children was studied to evaluate the risk of seizures and other neurological complications following DTP vaccination; 38,171 children received 107,154 DTP immunizations during the first three years of life and were followed for adverse reactions. The children lived in Tennessee and were receiving Medicaid; most were poor and nonwhite. Results showed that there was no increased risk of either afebrile (without fever) seizures or acute symptomatic seizures in the three days following immunization. Risk of febrile seizures in the three days after immunization was 1.5 times that observed during a control period, but this was not a significant increase in risk. No child who had no previous history of seizures had a seizure in the three days after immunization that led to either epilepsy or another developmental or neurological disorder. The results differ from some previous studies, which have reported an increase in febrile seizures after DTP immunization. (Consumer Summary produced by Reliance Medical Information, Inc.)

To the Editor.-- We acknowledge the publication of the article by Freeman et al entitled "Does Carnitine Administration Improve the Symptoms Attributed to Anticonvulsant Medications?: A Double-Blind, Crossover Study" in [...]

Abstract Objectives--The relation between complicated early childhood convulsion (ECC) and adult epilepsy is unclear, although a history of complicated ECC is obtainable in half of adults with epilepsy associated with [...]

Vaccination of children against pertussis has succeeded in preventing thousands of cases of mental retardation and death during the past 40 years. But the pertussis vaccine, now given in the form of a combined, diphtheria-tetanus-pertussis (DTP) vaccine, has been wrongly blamed during the past decade for causing brain damage. Three recent research studies, which combined involved 230,000 children and 713,000 immunizations, have demonstrated that the pertussis vaccine causes no permanent neurological damage. Another ongoing study has failed to implicate the pertussis vaccine in causing any form of encephalopathy (brain dysfunction). It is important that the phenomenon of 'pertussis vaccine encephalopathy' be recognized as a myth. The major error made by physicians who believed this misconception was to assume that neurological events occurring after vaccination were due to the vaccine, whereas this was apparently not the case. A group of parents who believed their children had been harmed by the vaccine organized to express their outrage, and were encouraged by the media and personal-injury lawyers. Some well-intentioned physicians joined the group, which became the National Vaccine Injury Compensation Program. This was unfortunate, as it created much national confusion and established an unscientific precedent for defining what is and is not a vaccine-related injury. Guidelines for risks and benefits of vaccines must be revised to reflect the most recent scientific data, in order to end this "national nonsense" about pertussis vaccine encephalopathy. (Consumer Summary produced by Reliance Medical Information, Inc.)

A 6-year-old boy presented with epilepsia partialis continua 6 months after diagnosis of type 1 diabetes. Anti-glutamic acid decarboxylase 65 antibodies were found in his serum and cerebrospinal fluid. Anti-epileptic agents did not improve his seizures. High-dose steroids, plasmapheresis, and intravenous immunogiobulin resulted in decreased anti-glutamic acid decarboxylase 65 antibody levels and resolution of his seizures. Pediatrics 2002;109(3). URL: http://www.pediatrics.org/cgi/content/full/109/3/e50; GAD65 antibody, type 1 diabetes mellitus, Rasmussen encephalitis, seizure, plasmapheresis, autoimmunity.

The case of a nine-month old girl who was treated for cocaine intoxication is presented; this episode was unusual in that it occurred after the baby accidentally ingested cocaine. Most previously reported cases of cocaine intoxication in young children involved exposure from the mother through breast feeding or prenatal exposure. Cases describing adverse neurologic reactions in adults due to cocaine use have been presented, but few reports have described similar reactions in children. Upon admission to the hospital this patient was evaluated for seizures and respiratory difficulty. The child had been found playing in a room that contained the leftover debris from a party held the previous evening. The parents acknowledged that cocaine was used during the party. Drugs to control the seizures were administered intravenously and the baby required respiratory assistance. Rapid pulse, low blood pressure, and elevated body temperature were recorded. No evidence of trauma was evident and the medical history provided no relevant information. The results of subsequent tests were normal or close to normal in most areas. The child was continued on phenobarbital until her respiration returned to normal and seizures were no longer observed. This case illustrates some significant points. Cocaine intoxication in young children does not occur exclusively as a direct result of maternal usage. Caution should be observed when potentially toxic substances are in the home with small children. Alcohol overdoses have been the most commonly reported occurrences in cases having similar circumstances. Small children may have less capacity to degrade cocaine, as witnessed by the persistence of symptoms in this case, and compared with similar cases of cocaine overdose in adults. In infants or small children with unexplained neurologic symptoms and seizures, cocaine intoxication should be considered in the differential diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)