SUMMARY The intellectual functions of 64 epileptic patients who had had an initial evaluation between five and 16 years of age, including the WISC, were re‐evaluated after a period of at least five years. In general the seizure states had improved, and 50 per cent were in remission for between two and eight years. All but four were still taking at least one anticonvulsant drug. WISC IQ estimates showed a slight decrease. Verbal and performance areas could be differentially affected, and a gain in one could be offset by a loss in the other, so the Full‐scale IQ might not be a reliable measure of day‐to‐day performance. Those whose seizures remained uncontrolled had a statistically significant decrease in performance IQ, whereas in general it was stable or increased for patients in remission. There was evidence that decreased IQ indicated slower mental growth rather than loss of previously acquired function. Phenobarbital but not phenytoin levels were inversely correlated with IQ, suggesting that the upper limit of the ‘therapeutic range’ of phenobarbital may already be toxic with regard to learning abilities. To optimize an epileptic child's functioning in school and to prevent long‐term intellectual problems, it is advisable that IQ testing should be part of the routine initial evaluation, and that drug levels should be checked at regular intervals. RÉSUMÉ Les fonctions intellectuelles de 64 épileptiques dont I'intelligence avait étéévaluée entre cinq et 16 ans, notamment par le WISC, ont été remesurées après une période d'au moins cinq ans. En général I‘état des crises s’était amélioré et 50 pour cent des sujets étaient en rémission pour des périodes allant de deux à huit ans. Tous les sujets sauf quatre prenaient encore une médication anticomitiale. Les QI au WISC montraient une légère perte. Les échelles verbale et performance pouvaient être modifiées de façon différente et un gain dans l'une des échelles pouvait être compensé par une perte dans I'autre, si bien que la pleine échelle de QI pourrait ne pas être une mesure fiable des performances journalières. Les sujets dont les crises demeuraient non contrôlées présentaient une baisse statistiquement significative à l‘échelle de performance, alors que cette échelle était en général stable ou en gain pour les sujets en rémission. Des signes indiquaient que la baisse de QI était davantage liée à un ralentissement de la croissance mentale qu’à une perte des fonctions antérieurement acquises. Les taux de phénobarbital mais non de phénytoine étaient inversement corrélés au QI, suggérant que la limite supérieure de “l‘étendue thérapeutique” du phénobarbital peut déjàêtre toxique en ce qui concerne les aptitudes d'apprentissage. Pour optimiser I'activité scolaire d'un enfant épileptique et pour prévenir des problèmes intellectuels à long terme, il est souhaitable que des mesures de QI fassent partie des évaluations initiales de routine et que les taux de médication soient contrôlés à intervalles réguliers. ZUSAMMENFASSUNG 64 Patienten mit Epilepsie, die zwischen fünf...

The P3 component to an auditory "oddball" stimulus was compared between 30 epilepsy patients and 27 age-matched normal controls. The P3 latency was significantly increased in the patients, but an increase beyond 3 standard deviations on two trials occurred in only 10 percent of the total sample and 13 percent when the age was restricted to less than 50 years. There were no significant differences in latencies for different seizure type or anticonvulsant levels. The best relationship on neuropsychologic performance was with the Trails B test. Since the exact latency of the P3 peak is at times difficult to determine and may involve arbitrary choices, it is proposed that when the test is used for clinical diagnostic purposes of dementia, the interpretation be limited to those instances where the P300 peak is either clearly normal or clearly present but prolonged beyond 3 standard deviations from age-matched normals. In the first instance, significant cognitive impairment is unlikely while it becomes very probable in the latter instance.

Both early (N1 and P2) and late (N2 and P3) event-related potentials (ERP) were obtained in 16 patients with complex partial seizures, 12 with left hemispheric ictal focus and 4 with right, to see if they help in lateralizing the seizure focus, and also to determine if they correlate with behavioral (MMPI, Bear-Fedio), attentional (Trails A and B), cognitive (WAIS-R, Boston Naming, Warrington Word and Face recognition) and mental speed (Stroop color naming and reading) tasks. Early waves were more often lateralized than late waves but both were often falsely lateralizing. Early waves were better correlated with behavioral tasks whereas late waves were better with those measuring mental speed, attention and cognition. These data tentatively discourage the utility of ERP in preoperative lateralization of seizure focus but argue for their potential value in psychophysiological correlations.

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