Kohji Ueda

ELECTROCLINICAL STUDY OF VIDEO-GAME EPILEPSY

Seven patients (five boys, two girls) with video‐game epilepsy (VGE) are reported, which reflects the fact that these games have increased in popularity recently among Japanese children. Their ages at onset ranged from four to 13 years. The seizure phenomena were of three types: generalised tonic‐clonic, partial seizure and headache. Interictal physical and neurological examinations were within normal limits. EEGs taken while they played video‐games confirmed the diagnosis of VGE and revealed three triggers of seizures: flashing lights, special figure patterns and scene‐changing. They were recommended to avoid playing video‐games, but sodium valproate was effective if seizures persisted even after such avoidance.

Autogenic Training as an Effective Treatment for Reflex Neurovascular Dystrophy: A Case Report

A 15‐year‐old girl complained of swelling and shooting pains in the right upper extremity, which had bothered her for seven months. Physical examination revealed swelling, cyanosis, weakness and hyperesthesia over the entire right upper extremity. Serological and biochemical data were within nod limits. She was diagnosed as having reflex neurovascular dystrophy (RND). Psychological problems with school and her family might have contributed to the pathogenesis of the disease. With autogenic training (AT), remission was obtained within eighteen months.

Human Erythropoietin in Children Undergoing Continuous Ambulatory Peritoneal Dialysis

The effect of intravenous recombinant human erythropoietin (rHuEPO) by two different dosage regimes was evaluated in 12 anemic children on continuous ambulatory peritoneal dialysis (CAPD). Eight patients (group A) were treated once a week at a mean dose of 89U/kg for 24 weeks. The other four patients (group B) were treated three times a week at a mean dose of 260 U/kg for 8 weeks, and then once a week at a mean dose of 88 U/kg for the next 16 weeks. In group A, the hematocrit (Ht) increased gradually and significantly from 19.9 ± 2.1% to 28.7 ± 1.5% at the 24th week, while in group B, it rapidly increased from 17.9 ± 2.5% to 30.2 ± 4.3% at the 8th week, and thereafter was maintained at a level of approximately 30%. However, there was no significant difference in the Ht between the two groups. In two of the four patients in group B, blood pressure increased from 136/87 mmHg to 168/102 mmHg and from 106/70 mmHg to 132/92 mmHg, at the 4th and the 8th weeks respectively, related to a rapid rise of the Ht. Neither antibody to rHuEPO nor other sides effect were evident. Gradual improvement of anemia by once‐a‐week intravenous administration of rHuEPO is advantageous for the quality of life in children on CAPD.

T cell activation and T cell receptor variable region gene usage in measles.

T cell activation and T cell receptor variable (V) regions were studied with monoclonal antibodies in peripheral blood lymphocytes from 22 patients with measles. Increased (> 5%) activated T cells (HLA‐DR+ CD3+ cells) were noted in 14 of the 22 patients. Elevations of Vβ5+ and Vβ8 + T cells were observed in two and four patients, respectively, and appeared to be associated with T cell activation. The duration of fever was significantly prolonged in those with increased (> 10%) activated T cells (p < 0.01). These results suggest that T cell activation and the preferential expansion of Vβ8+ and Vβ5+ T cells are associated with the pathogenic process of measles.

The Measles Outbreak in Chikuhou District, Fukuoka, Japan, 1990: Correlation between Herd Immunity Level and Outbreak Size

A measles outbreak occurred in the Chikuhou district of Fukuoka, Japan from May to October 1990, during which 71 patients were cared for at the Itoda Public Hospital. Hospital records revealed a large outbreak in the adjacent town of Kanada. In order to characterize the outbreak, questionnaires were sent to all preschool‐age children in Itoda (73% effective response) and in Kanada (76% effective response) requesting information about their vaccination and/or history of measles. The number of patients was 22 (4%) in Itoda and 63 (14%) in Kanada, most of these being preschoolers, while the vaccination rate was 61% and 44%, respectively. The herd immunity levels in age‐specific groups were compared between the two towns. Before the epidemic, the immunity level of 1 year old children in Kanada, who showed the higher attack rate, was lower (18%) than that in Itoda (39%), while after the epidemic it rose above 60% in both towns. When we studied the correlation between the attack rate and the vaccination rate, or the number of children susceptible to measles (susceptibility rate) in each preschool, the attack rate correlated negatively with the vaccination rate (correlation coefficient [CC] = ‐ 0.818; P < 0.01), and positively with the susceptibility rate (CC 0.860; P < 0.01). The regressed equation on the correlation indicated that the immunity level should be more than 70% to keep the attack rate under 5% in preschoois. After the epidemic, the immunity levels of all preschoolers reached above 70%. Early vaccination should be given to at least 70% of young preschoolers in order to prevent a large outbreak of measles under the present vaccination program in Japan.

Renal Osteodystrophy in Patients on Continuous Ambulatory Peritoneal Dialysis

Twelve patients on continuous ambulatory peritoneal dialysis (CAPD) were studied in order to evaluate the progression of renal osteodystrophy (ROD). All patients received doses of 0.01 ‐ 0.02 μg/kg of 1 alpha vitamin D3(1α ‐ D3) and 0.1 ‐ 0.15 g/kg of calcium carbonate for 12 ‐ 18 months. Serum total protein, total calcium (Ca), creatinine, inorganic phosphate alkaline phosphatase (ALP), and n‐terminal parathyroid hormone were measured regularly. The radiological bone appearance for ROD or rickets and the height standard deviation score were compared between the outset and the end of this study. An increase of Ca values and a decrease of ALP values correlated with a suppression of hyperparathyroidism, and the hyperphosphatemia was controlled in the majority of our patients throughout this study. Two patients had ROD and rickets at the outset of this study, and all patients but one had neither ROD nor rickets at the end of this study. Growth retardation improved or remained stable in 10 patients. Our results indicate that adequate doses of 1α ‐ D3 and calcium carbonate are effective in the prevention of ROD and rickets in patients on CAPD.

Rubella Vaccination and Congenital Rubella Syndrome in Japan

In 1977, a rubella mass vaccination programme was started in Japan for the prevention of congenital rubella syndrome (CRS). The programme scheduled rubella vaccination to junior high schoolgirls. However, during the current 1987 nationwide epidemic in Japan, rubella broke out extensively, questioning the effect of this mass vaccination programme. Especially, the occurrence of rubella among pregnant women, leading to the threat of birth of CRS children in the coming years, has aroused the interest of society toward rubella in Japan. Although birth of CRS children during the extensive outbreaks of rubella expected to occur in the latter half of the 1990s may be minimized, under the present Japanese rubella vaccination policy, we believe that complete elimination of CRS in Japan will be difficult, unless further measures against rubella are taken.

Childhood Leukemia and Lymphoma: Long-Term Sequelae in Visual, Auditory and Vestibular Function

Twenty‐six children in continuous complete remission from leukemia or lymphoma and no longer receiving chemotherapy were studied to determine the long‐term sequelae in visual, auditory and vestibular function. Ophthalmologic examination revealed cataracts in five patients and an abnormality in the retina in one patient. These abnormalities were not associated with any disturbance of visual acuity. By otorhinolaryngologic examination, slight hearing loss was observed in five patients and an abnoormal righting reflex in one patient. The etiologies of these abnormal findings in visual, auditory and vestibular function were discussed.

Efficacy of Once Weekly Erythropoietin Therapy in Children on Continuous Ambulatory Peritoneal Dialysis

The efficacy of recombinant human erythropoietin (rHuEPO) on 10 anemic children undergoing continuous ambulatory peritoneal dialysis (CAPD) was evaluated. A mean dose of 93 U/kg of rHuEPO was given once a week for 24 weeks, either intravenously to 5 children or subcutaneously to the other 5. Anemia improved in all children by this therapy. The mean hemoglobin and hematocrit levels increased gradually but significantly from 6.9 g/dl and 20.2% to 9.4 g/dl and 30.1%, respectively, at the end of the study. Elevation of blood pressure or other side effects were not noted in any patient. The present study indicates that the once‐a‐week injection of rHuEPO by the intravenous or subcutaneous route is effective in children undergoing CAPD.

Developmental Retardation in Children with Refractory Epilepsy

It is controversial whether developmental retardation occurs in children with epilepsy and what causes the retardation if it occurs. The present study aims to reveal the factors associated with the retardation. The patients were 126 children who had been developmentally normal before the onset of epilepsy and had been followed for more than five years. Fortyeight of the 126 children showed mental retardation, and the remaining 78 had normal mental development at the follow‐up. Developmental retardation was observed in children with onset before one year, known etiology, diffuse slow spike‐wave or hypsarrhy‐thmia on EEC, ingestion of six or more drugs and high blood levels of phenobarbital or phenytoin. Late onset of epilepsy, idiopathic or familial etiology, ingestion of five drugs or less and low blood level of phenobarbital or phenytoin were associated with normal development.