It is not known why the frequency of seizures sometimes increases in the perimenstrual period (catamenial epilepsy). We have examined the possibility that changes in anticonvulsant pharmacokinetics may be responsible. Seventeen women with seizures who were taking phenytoin (DPH) and whose seizures were more frequent perimenstrually were examined twice each, once on the first or second menstrual day and again after 2 weeks. Mean serum DPH levels were lower during the menses. In seven women with seizures unrelated to menses, the fall of DPH levels was much smaller. In catamenial epilepsy, the fall was due to increased DPH clearance. At the time of ovulation, hepatic DPH metabolism may be slowed by competition from steroid hormones.

A patient with hyperthyroidism is described who developed grand mal seizures when anth-thyroid medication was withdrawn. Pyramidal signs were also present. The EEG reverted to normal and the clinical signs and symptoms disappeared when his thyroid status was again controlled.

Neurological complications following rubella are only rarely encountered. However, in many cases severe neurological impairment may occur, leading to permanent disability. In a recent epidemic of rubella in Israel during the years 1978-1979, 20 patients with severe neurological complications have been seen. We report on 5 cases of which 3 are described in detail. Considering the efficacy of immunization against rubella, we suggest that in countries such as England and Israel in which periodic epidemics of rubella occur, a generalized plan of immunization should be undertaken during the first years of life. Such an approach will prevent the neurological complication of congenital, as well as acquired, rubella infection.

No abstract

Pupillary dilatation was observed in a young boy who had a sudden onset of right focal seizures. Clinical and laboratory investigation revealed the presence of a benign left frontal epileptic focus. Lacking signs of third cranial nerve compression, this transient pupillary abnormality could be caused by the contralateral frontal epileptic focus. Such a focus might inhibit dilatation of the homolateral pupil, thus permitting dilatation of the contralateral pupil only. Unilateral mydriasis as described hereby could also represent a pupillary "Todd's Paralysis" caused by the contralateral frontal epileptic focus.