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Objectives: The aim of this study was to establish the predictive value of an ICD-10 diagnosis of depressive disorder or dysthymia (depressive patients) among 70 years + frail rural community living patients by measuring morbidity, mortality and use of health services. Identical measures were studied over time in general elderly populations., Outcome Measures: morbidity, mortality and use of health services were registered over 13 years in: (i) a clinical cohort of frail community-living depressive patients (n = 38), a frail control group (n = 116) and non-frail elderly people (n = 575), all living in the same municipality, and (ii) register-based samples of general rural (n = 4 115) and capital living (n = 54 977) elderly populations. The outcome measures were compared using data from Danish national health registers., Results: Every one of the clinical cohort of depressive patients had died at the end of the study. Compared with both the frail control group and the non-frail elderly people, the depressive patients had significantly more psychiatric hospital days, outpatient home visits, antidepressant use, antipsychotic use, GP service use and more psychiatric diagnoses with higher morbidity. However, greater use of somatic hospital services or more somatic diagnoses among the depressive elderly patients were not observed. The general elderly population living in the capital had, compared with rural equals, significantly more somatic and psychiatric diagnoses, larger use of somatic hospital services, psychiatric hospital days, antipsychotics and anxiolytics, but less use of antidepressants, psychiatric outpatient home visits and GP services., Conclusions: An ICD-10 diagnosis of depressive disorder or dysthymia predicted increased use of psychiatric services, more psychiatric diagnoses and increased mortality, indicating poor late-life psychiatric outcome. Contrasting with other studies, depression did not predict increased use of somatic hospital services or more somatic diagnoses. The differences in health care status and use between elderly living in the capital and in rural areas elderly are novel findings.

The study aims to establish the predictive value of a diagnosis of depression among elderly according to the 10th revision of the International Statistical Classification of Diseases (ICD-10) by measuring morbidity, medication usage, health service utilization and mortality during an 8-year follow-up of depressed elderly inpatients (n=76) and community-living depressed patients (n=38) compared with controls (n=116). The data were taken from GPs' medical records and health statistics registers. At baseline, no significant differences were observed between the two cohorts of depressed patients and the controls in terms of prevalence of cardiovascular, respiratory or cerebrovascular morbidity. During follow-up, both cohorts of depressed patients had significantly increased rates of recurrent depressions, consumption of antidepressants, psychiatric in- and outpatient admissions, and home visits; inpatients used more psychiatric hospital days. Health service utilization in somatic hospitals and somatic diagnoses was not significantly increased. Inpatients used significantly fewer GP office-hour services but more out-of-hours services than the control group. Community-living depressed patients experienced no significant increase in use of GP services. Survival was unaffected in both cohorts. In agreement with other studies, especially inpatient depression predicted increased rates of recurrent depressions and increased use of psychiatric hospital services, indicating poor long-term outcome. Inpatients consumed fewer GP office-hour services but more out-of-hours services, possibly due to less office-hour contact. Contrasting with other studies, ICD-10 depression among elderly predicted no increase in the use of somatic hospital facilities.

Affecting 3% of the old-age population and 10-20% of elderly patients with chronic medical illness or dementia, depression is an important health problem in late life. Depression with first onset in late life differs from early-onset depression clinically as well as by more organic cerebral involvement. If untreated, depression in the elderly leads to severe disability and to excess mortality by suicide and by adverse outcome of medical illness. The response to antidepressant drugs in old age is on the same level as in younger age-groups, and as less than 1 in 5 elderly people with depression is diagnosed and treated, there is substantial room for improving the prognosis of old-age depression.

Objective: The aim of the study was to assess the external and internal validity of the 6- and 17-item versions of the Hamilton Rating Scale for Depression (HAM-D(6) and HAM-D(17)), the Bech-Rafaelsen Melancholia Scale, the 15- and 30-item versions of the Geriatric Depression Scale, and the Cornell Scale for Depression in Dementia in a population of depressed demented and nondemented Danish elderly., Method: Two clinicians performed independent, blinded assessments of the study population, which was drawn from psychogeriatric outpatient clinics, and a control group of elderly subjects. Concurrent and convergent validity were assessed using correlation coefficient analyses, and to evaluate the internal validity, item response analysis using the Mokken coefficient and Rasch analysis was performed. A coefficient of homogeneity of 0.40 or higher indicated scalability. Data collection took place between October 2001 and April 2004., Results: 145 subjects were included; 102 were female (mean age = 78.6 +/-6.8 years), and 43 were male (mean age = 72.4 +/-5.6 years). In the study group (N = 109), 73 subjects had depression only, and 36 had both depression and dementia; in the control group (N = 36), 11 subjects had dementia. The item-response analysis made a clear distinction between the scales. The HAM-D(6) was the only scale that fulfilled the criterion of total scalability in both the cognitively intact and the impaired populations. In terms of standardization according to the Clinical Global Impressions-Severity of Illness scale (CGI-S), the HAM-D(6) had the most convincing external validity overall. In terms of general correlation to the CGI-S, only small differences were shown between the scales., Conclusion: The HAM-D(6) should be separately considered even when longer HAM-D versions are used for the measurement of depression in elderly persons.

Introduction: Although delirium is a reversible cerebral syndrome, the effect of treatment of the elderly is unsatisfactory, involving prolonged hospitalizations and increased risk of relapse and mortality. The purpose of this study was to evaluate whether hospitalization for delirium (severe delirium) diagnosed by ICD-10 criteria predicts increased morbidity, utilization of health services and mortality., Materials and Methods: Delirious inpatients (n = 26) discharged after treatment in an old-age psychiatric university clinic were studied for nine years. In a register-based design, the above-mentioned parameters of the delirium cohort were compared with a group of controls (n = 116)., Results: There was a trend to increased mortality in the delirium cohort. Compared with the controls, the delirium cohort had a significantly increased incidence of disorders of vital organs, serious psychiatric disorders, particularly depression, increased use of hospital psychiatry and general practitioner's out-of-hours service, but less use of office-hour services. The incidence of delirium in the cohorts was low. In the delirium cohort, there was no significantly increased use of services or the number of diagnoses in somatic hospitals., Conclusion: Increased somatic and psychiatric morbidity and a trend to increased mortality indicate a serious prognosis after severe delirium in the elderly. It is noteworthy that the delirium cohort had increased use of GPs' out-of-hours services but less use of office-hour services.

Behavioural and psychological symptoms of dementia (BPSD) are common and can dominate disease presentation. Antidepressions are commonly prescribed for depressive symptoms, but the evidence to support this practice is weak. The atypical antipsychotics risperidone and olanzepine have significant efficacy for the treatment of aggression and risperidone is also efficacious in the treatment of psychosis, but both with substantially increased risk of stroke. There are no newer studies of benzodiazepines in the treatment of anxiety and in old studies the efficacy are doubtful.

Objectives: To describe the criterion validity of nursing home staff's assessment of organic disorder compared with ICD-10 criteria, and to identify determinants of staff assessment of organic disorder., Method: Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. Nursing staff members were interviewed about the residents' activities of Daily Living, behavioural problems, orientation in surroundings and communication skills, and asked if the resident had an organic disorder. Multiple logistic regression was used to select the items that most strongly determined staff assessment of organic disorder., Results: Sixty-two per cent of the residents were diagnosed by GMS-AGECAT as having organic disorder, 78% of these were correctly identified by the staff. Whether analysed among residents with or without organic disorder, or in the total group of residents, the staff assessment of the presence of organic disorder depended on a limited set of behavioural characteristics of the resident, namely 'going to the toilet in inappropriate places', 'saying things that do not make sense' and impairment in orientation., Conclusions: Staff comprehension of organic disorder resulted in over- as well as under-labelling of residents, a tendency that will affect communication with medical personnel and may lead to inadequate or wrong medical treatment and to negative performance as well as negative role expectations in everyday life in nursing homes.

Purpose: To characterise the prescription pattern of psychotropics in Danish nursing homes and to identify diagnostic, behavioural, cognitive and performance characteristics associated with prevalent psychotropic drug use., Methods: Prescribed daily medication was recorded from nurses' files. Based on the Anatomical Therapeutical Chemical (ATC) classification index, psychotropics were categorised into neuroleptics, benzodiazepines and antidepressants. Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. One hundred and eighteen staff members were interviewed about the residents's Activities of Daily Living (ADL), behavioural problems (Nursing Home Behavior Problem Scale), orientation, communication skills and if the resident had any psychiatric disorder. Multiple logistic regression was used to select the items that determined the use of psychotropics., Results: Fifty-six percent of the residents received a psychotropic, 21% received neuroleptics, 38% received benzodiazepines and 24% received antidepressants. In the multivariate analysis, staff assessment of the resident's mental health was a determinant for the use of all types of specific psychotropics, whereas a GMS-AGECAT diagnosis only determined the use of neuroleptics. Behavioural problems were a determinant for the use of neuroleptics and the use of benzodiazepines irrespective of the psychiatric diagnosis of the resident. Use of antidepressants was associated with male gender and increasing age., Conclusions: Staff perceptions of psychiatric morbidity and norms have a greater impact on the prescription of psychotropics than standardised clinical criteria., (Copyright 2001 John Wiley & Sons, Ltd.)

Missing items in the Mini Mental State examination are dealt with in different ways. The main aims of this study were to calculate a weighted item score for organic disorder on the basis of the item score of the Standardized Mini Mental State Examination (SMMSE) test regardless of the completeness of the test and to compare the criterion validity of the weighted scores with the ordinal scores for the SMMSE test. With a participation of 91%, the study included 100 nursing residents. All residents were tested with the SMMSE test and concurrently diagnosed in accordance with the ICD-10 by a consultant psychiatrist. The two assessments were mutually blinded. Multiple conditional forward logistic regression was used to select the items that most strongly predicted organic disorder as assessed by the psychiatrist. The weighted score had significantly better validity parameters, performed better on a receiver operating curve (ROC), and was better at dichotomizing the population into organic disorder than the commonly used ordinal score. We propose that missing items in the SMMSE should be scored as missing and included in empirical weighting on SMMSE items, which will then be substantially more valid than the SMMSE score itself.

Unlabelled: The prevalence of depressive disorders (D) in 70 years of age or older frail elderly was studied. Two hundred and eleven (81%) recipients of Municipal Home Help Service (frail elderly) in a rural area of Jutland were included and screened by the Geriatric Depression Scale-15 (GDS). If participants had: a) a GDS-score > or = 5 points or/and b) a history of depression, further evaluation was given by: 1) general practitioners (GPs) (implicit criteria), 2) a psycho-geriatrician (ICD-10 criteria), and 3) a geriatrician with the Hamilton Test for Depression. Prevalence rates for D among the evaluators: 15-18%. The diagnostic agreement was only fair., In Conclusion: 18% of the studied population fulfilled the ICD-10 research criteria for depression. The GDS may help GPs in diagnosing depression among frail elderly. False GDS negatives, found among GDS negatives with a history of depression, should be evaluated thoroughly when identifying depression in the target group.

The purpose of the study was to describe a Danish nursing home population. The study consists of 288 nursing home residents (median age 84.6 years, 68% females). The psychiatric morbidity of the residents was diagnosed with the GMS-AGECAT. The staff was interviewed about the residents' ADL, disturbing behaviour and therapeutic measures. Seventy-one percent had a psychiatric disorder, with organic disorder as the most frequent (61%). Demented residents received significantly less hypnotics, were more often physically restrained and had lower ADL levels compared to other residents. The situation in Denmark can be seen as a paradox. While substantial effort has been made to increase the possibility of choice and to "deinstitutionalize" nursing homes, the majority of the residents are demented and thus not capable of making valid choices.

The purposes of the study were to account for aetiology, treatment concept, outcome of treatment, and discharge destination of delirious elderly inpatients. During one year all patients in a psychogeriatric university department were assessed on admission and at discharge with a selection of assessments measuring psychopathology, behavioural disorders, depressive symptoms, intellectual functioning, activities of daily living, and gait. Diagnoses were made according to the ICD-10 criteria for research. All patients with a principal diagnosis of delirium (n = 26) are accounted for. Delirious patients improved their health status significantly in all the assessments, and 86% of patients admitted from independent living were discharged to independent living. It is concluded that elderly inpatients with severe or prolonged delirium profit significantly from the treatment concept in all of the rated health aspects.

Unlabelled: The objectives were to study clinical symptoms of major depression in later life by using relevant assessment scales of psychopathology, behavioural disorders, and physical functioning. The evaluations on admission and at discharge were based on interdisciplinary observations and interview of patients. The study was carried out during twelve months in a psychogeriatric university department and encompassed 202 patients. All (N = 80) (40%) patients who had a principal diagnosis of major depression are accounted for. Mean age was 79.5 years. Results of the assessments all showed significant improvements (p = 0.0000-0.0024). The overall results of the assessments show that the key symptom of sadness is often missing, muted, or overshadowed by other symptoms, and that behavioural disturbancies and functional disability may be important symptoms in geriatric depression., In Conclusion: adequate treatment of major depression in the elderly significantly improves psychopathology, behavioural disorders and physical functioning. When dealing with mental disorders in this age group, awareness of the five clinical presentations in major geriatric depression, i.e. dementoform, somatoform neurotiform, eretic and classic geriatric depression, may target the diagnostic procedure.

Aim: To validate the Danish version of the GMS-AGECAT (A3), the Standardized Mini Mental State Examination (SMMSE) and the Geriatric Depression Scale-15 (GDS-15) by comparing them to clinical ICD-10 criteria in a Danish nursing home population., Methods: With a participation of 91%, the study included 100 residents. All residents were interviewed with the GMS-AGECAT (A3), SMMSE and GDS-15 by an MD and then blindly diagnosed by a consultant geriatric psychiatrist. All residents approached for an interview were included, also those who were not able to communicate (the non-accessibles)., Results: The prevalence of clinical psychiatric ICD-10 main diagnoses was 56%. The non-accessibles had significantly higher psychiatric morbidity and lower ADL scores (modified Barthel ADL index) compared to those who were able to communicate. With the non-accessibles (N = 100) included, the optimal screening and diagnostic cutpoint for the GMS-AGECAT organic diagnoses was 2/3, with 96% sensitivity, 73% specificity, 77% predictive value of a positive test and 95% predictive value of a negative test. The SMMSE and GDS-15 had better screening properties compared to the GMS-AGECAT but only 60% of the residents were able to complete the SMMSE and 78% were able to complete the GDS-15., Conclusion: The Danish version of the GMS-AGECAT has relevant diagnostic and screening properties for organic disorders in Danish nursing home populations.

Case reports of 110 patients referred to a neurological dementia clinic were reviewed to evaluate a standardized diagnostic program. The patients were evaluated by a neurologist, a gerontopsychiatrist, and a neuropsychologist. ICD-10 criteria were used. Fifty-two patients had dementia while 58 had not; of these, 27 suffered from other non-dementia diseases and 31 were without dementia or other psychiatric or neurological disease. Thirteen patients with Alzheimer's disease were treated with tacrine. Four patients underwent cobalamin substitution treatment and seven started antidepressant medication. Ten patients received acetylsalicylic acid (150 mg Q.D.) and two a levo-dopa-type drug. Twenty-six patients were followed by gerontopsychiatric district care. Because only 47% of the patients suspected of dementia actually fulfilled dementia criteria, the evaluation suggests that patients suspected of dementia benefit from a standardized diagnostic program in a specialist setting.

During one year all patients with a diagnosis of depression in accordance with ICD-10, referred to a psychogeriatric department, were assessed at admission and discharge with a number of rating scales: The Brief Geriatric Depression Scale, Katz' ADL-index, the Multidimensional Dementia Assessment Scale, the Mini-Mental State Examination and the Functional Ambulation Classification. The department has an active stepwise treatment strategy: SSRI (selective serotonin reuptake inhibitor), potentiation with mianserin, lithium potentiation, ECT. The 87 depressive patients had a median age of 79 and most had one or more severe somatic conditions. Fifty-nine were severely depressed at admission, 19 at discharge; the number of functionally disabled dropped from 22 to seven and the number of cognitively impaired from 35 to 19. In conclusion, a nihilistic approach to treatment in the very old is unfounded.

The cobalamin status was evaluated in Alzheimer dementia (n = 26), other dementias (n = 24), various gerontopsychiatric disorders (n = 25), and in neuro-psychiatrically healthy controls (n = 20). Supplementing serum cobalamin we measured methylmalonic acid (MMA), a metabolite accumulating early in cobalamin deficiency. Subnormal cobalamin and/or clearly elevated MMA concentrations were found in 11 cases: 7 Alzheimer patients (27%), 2 with other dementias (8%), one psychiatric patient (4%), and one control (5%). None presented the typical neurologic features of cobalamin deficiency and macrocytosis was found in only one. The mean cobalamin concentration was significantly lower in Alzheimer patients (179 +/- 18 pmol/l) than in the age-matched controls (256 +/- 23 pmol/l) (p = 0.013) and the other patient groups. Correspondingly, the mean MMA level was higher in the Alzheimer group (0.480 +/- 0.062 mumol/l) than in any other diagnostic group (controls: 0.347 +/- 0.040 mumol/l). Comparing the Alzheimer group to the other groups as a whole, the elevation was significant (p = 0.0097). Our findings indicate that Alzheimer patients are particularly prone to cobalamin deficiency, and even subtle biochemical signs of deficiency seem to justify treatment.

Behavioral-disturbed elderly patients with dementia are often treated with psychotropic drugs, frequently by doctors who only have sporadic contact with such cases. Knowledge concerning psychotic symptoms and behavioural disturbances in dementia has increased over the past years, as to a certain extent has the number of investigations of psychopharmacological therapy in demented patients. Based on results of controlled drug trials and empiric consensus among psychogeriatricians, recommendations and guidelines regarding indications for drug therapy and type of psychotropic drug suitable for the treatment of psychiatric problems in dementia are given.

The psychogeriatric department in the county of Arhus is in a unique position to collect cases of old people treated with psychotropics in various inappropriate ways in hospital wards or by general practitioners. In 1991 the department was in contact with 768 elderly people mostly on an outpatient basis among whom 40 patients exhibited accumulated errors of psychopharmacologic treatment. The treatment episodes were analysed. The patients were very old (mean 80.8 years) with severe somatic morbidity. A majority were demented or delirious. 75% were living in nursing homes. The treatment episodes exhibited polypharmacy and large doses of neuroleptics (mean 0.7 DDD/day) or benzodiazepines (mean 1.41 DDD/day). Psychotropics not suitable for elderly patients were used in 34 patients. Indications for treatment were mostly unspecified behavioural disturbances, sometimes reflecting inappropriate social support. The majority of patients had side effects, sometimes rendering the patient more acceptable to staff and other residents.

Psychotropics are to a great extent used in nursing homes to sedate and incapacitate the residents for social reasons. The very high prescription rate also reflects gerontophobic and dementophobic myths placing the old and disturbing patient beyond general accepted ethical rules. The problem is highlighted by the new Danish law concerning the uncurable ill patient. Under certain conditions it is now legal not to treat demented people for a life threatening but treatable physical illness. The boundaries between active and passive euthanasia seem more and more blurred concerning old demented patients.

In 32 nursing homes selected at random in the 16 counties in Denmark, the use of psychotropic medication was studied in all residents aged over 65 years (1454 persons) by interview of nursing staff and review of treatment records regarding drug group, dose, duration of treatment and target symptoms. Psychotropic prescriptions were recorded in 56% of the elderly. The frequency of residents receiving daily treatment with neuroleptics was 20% and for anxiolytics, hypnotics and antidepressants 13%, 33% and 11%, respectively. The duration of treatment was two to three years. The indications were mostly unspecified behavioural disturbances. The use reflects the high psychiatric morbidity in nursing home residents, especially regarding dementia. From what is known of therapeutic efficacy and side-effects, it is concluded that the prescription rate is too high, duration of treatment much longer than necessary and that drugs inappropriate for elderly are often used.

The field of psychogeriatrics, including diagnosis and treatment of age-associated dementia, is still in its early years in Denmark. Most of the treatment of the elderly with psychiatric conditions lies in the hands of general practitioners and staff of somatic nursing homes. In a few places in Denmark, a more academic approach to the elderly patients has developed in general psychiatric hospitals. Psychogeriatric department D at The Psychiatric University Hospital in Arhus is an example. Treatment ideology, strategies, education, outpatient treatment and hospital-treatment is described, especially regarding age-associated dementia.

This paper describes the admission and discharge pattern in a psychiatric hospital for 315 senile and arteriosclerotic demented patients (290.09, 293.09 ICD-8) aged 65 years and over and admitted for the first time. 47% (149) of the patients were admitted from other hospitals and temporary stays in nursing homes. A total of 203 (65%) of the patients experienced one or more changes of residence during the three months prior to admission to the psychiatric hospital. A Kaplan-Meier analysis showed that 25% of the patients were still hospitalized 48 weeks after admission. A total of 62 patients died in the psychiatric hospital, one patient was still hospitalized when the investigation ceased. Of those discharged alive 201, (80%) were discharged to nursing homes 26 (10%) to their own homes and 25 (10%) to hospitals. Of those who had their own home at the time of admission and were discharged alive only 16% were discharged to their own homes, the remainder were discharged to nursing homes and hospitals. On account of the many changes of environment the demented patients experience prior to admission to the psychiatric hospital, they risk developing confusional psychoses which may be disastrous to their physical and mental health.

Case records of 404 elderly patients (aged 65 years or more) who were admitted for the first time to the Psychiatric Hospital in Aarhus were investigated retrospectively. In 315 patients the diagnoses were senile dementia (290.09) and arteriosclerotic dementia (293.09) according to ICD-8. Information about use of psychotropic drugs before admission and on discharge alive was obtained from the patient case records. In the present study, the use of drugs was not found to be correlated with age, sex and degree of dementia. Significantly fewer committed patients were treated with psychoactive drugs and significantly fewer lived independently in their own homes. Only 42 (13%) patients had a crude psychiatric disorder while 251 (80%) were admitted on account of unacceptable behaviour. 90% of the latter group of patients had been treated with one or more psychoactive drugs on admission. The risks involved in the use of psychoactive drugs are discussed. On account of demographic changes in the Danish population and the recent decrease in psychiatric hospital beds and nursing home beds, it is recommended that the patterns of committed admissions of demented patients to psychiatric hospitals should be followed closely.

The contralateral and ipsilateral somatosensory evoked potentials (SEP) after stimulation of the right and left median nerve were recorded in 10 patients with chronic schizophrenia and in 10 normal subjects. The ipsilateral SEP depends on the function of the corpus callosum. The latency-delay from peak 5 in the contralateral SEP to the analogous peak in the ipsilateral SEP was significantly reduced in the patients, but only from the left to the right hemisphere. This peak presumably represents interhemisphere transfer and function of corpus callosum. The amount of synaptic activity--measured by the mean amplitude of the SEP--in the right hemisphere, relative to the activity in the left hemisphere after stimulation of the right median nerve, was also greater in the patients. These differences could be interpreted as an abnormal function of the corpus callosum and as a breakdown of the lateral specialization of the left cerebral hemisphere in schizophrenia.

Cerebral asthenopia is often overlooked as a symptom in diffuse brain lesion. An objective correlate of this symptom has so far never been demonstrated. Averaged visual evoked potential (VEP) in 10 patients with asthenopia was compared with 20 normal subjects. Both eyes and each eye alone were stimulated using bipolar recording in the midline and over each of the occipital lobes. There was no difference of latency of the VEPs in the two groups, but the amplitude of the most prominent component was significantly reduced in the patients. There was also a difference in the two groups regarding habituation and lateralisation. No amplitude difference could be found in the somatosensory evoked potential. The amplitude difference in VEP, as an objective correlate of asthenopia, is probably modal specific and suggests involvement of the visual cortex. VEP is unsuitable as a diagnostic tool due to the great overlap between amplitudes in asthenopic patients and control subjects.

Twenty male chronic schizophrenic patients participated in a double-blond between-patient study of the GABA-like drug baclofen to evaluate the antipsychotic effect of baclofen. No difference was found between the 10 patients who received baclofen and 10 who received placebo with regard to the number of days before a worsening of their psychiatric condition necessitated treatment with chlorpromazine, the total score for psychotic symptoms before and after treatment for 10 weeks, or the total consumption of chlorpromazine. Discontinuation of baclofen did not exacerbate the psychotic symptoms. Baclofen was superior to placebo in the treatment of anxiety, which is of particular interest in view of the recent theories on the mechanism of action of benzodiazepines. The relationship between the gabergic system and the dopaminergic system with regard to the substantia nigra and the corpus striatum is discussed as well as the suggestion based on animal experiments that baclofen has an antipsychotic effect.

In order to determine the borderlines of the benign partial epilepsy of children with centrotemporal spike foci ('Rolandic epilepsy') 43 patients with epilepsy and spike foci in the centrotemporal region or elsewhere drawn from the EEG files were re-evaluated as adults. The prognosis was equally good whether the spike focus was in the centrotemporal region or elsewhere, and synchronous paroxystic activity did not make the prognosis worse, but focal temporal low frequency activity did. It is suggested that borderline cases exist between 'Rolandic epilepsy' and other age dependent epilepsies.