Psychiatric symptoms can occur following a seizure (post‐ictal) in patients with epilepsy. Here, Drs Datta and Oladinni describe the case of a man with a history of nocturnal epilepsy, who developed psychotic symptoms following two successive seizures. Copyright © 2014 John Wiley & Sons

Dacrystic seizures I Case notesA nine-year-old girl with a back- Key learning points• There is a high rate of psychiatric comorbidity with epilepsy.• Seizures that involve an affective component, such as dacrystic or gelastic seizures, can still be comorbid with psychiatric disorders that require intervention from mental health teams.• Dacrystic seizures are rare occurrences, but if missed can impact significantly on quality of life.• There is a strong need to have a very clear understanding of the clinical presentation, and unhindered communication between both psychological and physical health services.• The appreciation of the overlap between physical and mental health symptomatology for doctors in specialty training is likely to contribute to robust service provision in the future.

Obese children often present with somatic illness such as headache and pain. However, less well documented are the associated psychological comorbidities. The authors describe a case of a 12‐year‐old severely obese boy that highlights the need for an holistic approach to address psychiatric as well as physical needs.

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LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUESSuppl. 2 -S23 to initiation of quinidine, this patient experienced 22 electrographic seizures over 24 hours. At target dose, this patient experienced greater than 70 seizures over 24 hours. Conclusions: Quinidine has previously been reported to be effective in patients with MMPSI with the same and different mutations. We report the second case of a patient with MMPSI and KCNT1 mutation R428Q with poor clinical response to quinidine. P.037Role of epilepsy monitoring unit in the investigation of patients with epilepsy and developmental delay Background: A significant part of the developmental delay (DD) population has epilepsy (26-70%) and live in an institution. These patients tend to have atypical presentation of epileptic seizures with higher risk of misdiagnosis. Distinguishing their ictal events from paroxysmal behaviors can be challenging.There often is a lack of description of the spells or inadequate history from the caregivers or the patients. These patients often have drug resistant epilepsy requiring polypharmacy with increased risk of morbidity and mortality. The aim of this study was to determine usefulness of Epilepsy Monitoring Unit (EMU) in diagnosis and management of these patients. Methods: This is a retrospective observational study of the patients with epilepsy and DD living in institutions that were admitted to the EMU. Results: Four patients met the inclusion criteria for this study. The mean age was 45(29-71), 3/4 (N=3) were male and 3/4 had focal epilepsy. All patients had mood disorders and 2 were taking antipsychotic medication. The mean admission-time was 6,25 days (2-15) and there was a correlation with the events and seizures in 2/4 of the patients and the rest had a combination of behavioural-changes and seizures. Conclusions: EMU admission can provide an accurate diagnosis of spells in patients with DD and epilepsy, and improve their quality of life. P.038Clinical experience with perampanel for refractory pediatric epilepsy in one Canadian center Background: Perampanel (PER) is a new anti-seizure medication that inhibits the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) class of glutamate receptors. It is available in Canada for children since 2014. It is important for physicians to be aware of the efficacy and tolerability of drugs in the post-marketing phase. Methods: We did a retrospective review of our experience with PER at BC Children's Hospital. Patients on PER were identified. Clinical data, including demographics, efficacy, tolerability, adverse effects (AE) and retention rates were obtained by review of clinical records. Results: Of 24 patients pediatric patients prescribed PER, 21 (87%) had focal and three had symptomatic generalized epilepsy. Ten (42%) had greater than 50% reduction in seizures. In fifteen patients, (63%) PER was discontinued due to AE or poor response. Twelve