Transcranial color-coded real-time sonography (TCCS) was applied to 26 patients with ventricular enlargement to quantify the ventricular size and to estimate intracranial pressure. Intracranial pressures, as determined by lumbar, epidural, or ventricular tonometry, ranged from 6.5 to 55 cm H2O (8 patients had pressures > 18 cm H2O). The widths of the third ventricle and the frontal horns of both lateral ventricles depicted by TCCS were compared to corresponding computed tomography data: TCCS and computed tomography findings correlated well for the third ventricle (r = 0.96) and for the right (r = 0.86) and left (r = 0.92) frontal horns. The capability of the septum pellucidum to undulate relative to the ventricular wall during short (20-degree) rotatory movements of the head was related to intracranial pressure. In all patients with intracranial pressure below 17 cm H2O, rotatory head movements induced septum pellucidum undulation; no lateral deflection of the septum pellucidum was found in patients with an intracranial pressure above 21 cm H2O. Therefore, TCCS may be employed to quantify and follow-up ventricular enlargement. Dynamic neurosonographic tests may allow a gross estimation of intracranial pressure.

Both Sulthiame and Levetiracetam influence the EEG of children with BECTS. Persistent EEG pathologies are associated with treatment failures.

"c*rr' JS /) oiicfetice tojirst cirrtborcit Univcrsitnctsklinikiim Essen, Kindcrklinik. I lufcl;indhtr. 55.1)-45 122 Esscn.(krmany. tiAlthough epilepsy is commonly associated with shunt-treated hydrocephalus, its relation to the shunting procedure and the criteria identifying postoperative epilepsy remain controversial. Of 283 patients shunted at Wurzburg Univeixity Hospital over a 24-year period (1970 to 1994), 182 were followed up for a minimum of 1 year after shunt .insertion and entered the study. The data were analyzed retrospectively in 1995 aud 1996. Epilepsy was analyzed in relation to the etiology of hydrocephalus. functional status, time and site of shunt insertion, onset of seizures and seizure type, EEG changes, sex, shunt systems, and shunt revisions. Of the 182 patients studied, 37 (20%) developed epilepsy. The incidence of epilepsy varied according to the etiology of hydrocephalus: posthemorrhagic (5% 1, postinfectious (4%), connatal/miscellaneous/unknown (3% 1, myelomeningocele (2% ), tumor/arachnoidal cgstlaqueduct stenosis (0%).Early shunting and poor functional status was associated with a higher risk for epilepsy. Epilepsy was not influenced by sex, shunt systems, or number of shunt revisions. Twenty-two (12%) of 182 patients developed epilepsy (generalized N=13, focal N=9) after intracranial shunting. Focal EEG abnormalities (N=16) were located mainly at the anatomical site of the shunt (N=14), but only three patients (2%) presented with focal seizures contralateral and focal EEG abnormalities ipsilateral to the site of the shunt. The presence of epilepsy was determined by the etiology of hydrocephalus rather than by surgical intervention. The incidence of postoperative epilepsy (12%) was low. Onset of epilepsy, clinical presentation of seizures, and EEG changes did not appear to be valid criteria for identifying shunt-related epilepsy. Thus, epilepsy as a complication of intracranial shunting might be overestiniated in the literature.Epilepsy is reported to be conimonly associated with shunttreated hydrocephalus (Hosking 197 Method Bctwcen 1970 and 1994, 283 children with hydrocephalus undcnvcnt intnventricular shunting at \Vuriburg Ilniversiiy Hospital. One hundred and eighty-two patients who had initial shunting at this hospital were studied and follow-up was done in the outpatient clinic by a senior neuropediatrician (MB) for :it least 1 year (range 1 to 2 1 years).'I'he datx were anal!xd for ( 1) etiology ofhydrocephalus; Followv-up assessnicnts were scheduled for twice a year unless complications demanded niorc frequent assessments. Parents or carL.givcrs were instructed to observe and record seizures, and seizures were evaluated by nruropediatricians (IMB, I I-MS) as obscmcd and described by parents and medical staff during hospital admissions. EliGs were not taken routinely, but in each cliild who developed seizures, subsequent EliGs were obtained and a n n l p t l in our clinic.

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