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Seven cases of aseptic meningitis were diagnosed in an intensive care nursery within the same period of time that 12 infants and older children with aseptic meningitis were admitted to the pediatric services of two hospitals in the same city. In two of the seven neonatal cases, and in seven of the 12 cases in older children coxsackievirus B5 was isolated from either spinal fluid or rectal swab specimens. Routine isolation precautions were insufficient to contain the spread of infection within the nursery. A comparison of the spinal fluid findings and clinical symptoms demonstrated a broad spectrum of severity in both neonates and older children. No neonates or young infants developed myocarditis. The possible sources of infection and the implications of nursery participation in a community epidemic are discussed.

Carbamazepine is an anticonvulsant most effective in treating complex partial and generalized tonicclonic seizures. We have cared for three children in whom four episodes of dystonia proceeding to opisthotonus occurred in association with carbamazepine use. The patients, a 4-year-old with microcephalv and severe retardation, a 1-year-old with cerebral dvsgenesis, and a 5-year-old with spastic quadriplegia and mild retardation, all had seizures unresponsive to multiple anticonvulsant combinations. In all three patients carbamazepine was introduced and gradually increased to a maximum dosage of 25 mg/kg of body weight per day. Dvstonic symptoms began two to three weeks after introduction of therapy and subsided within three weeks after discontinuation. In one child, a second course of carbamazepine resulted in a return of the dystonia. The currently available clinical and neuropharmacologic data suggest that carbamazepine may be an antagonist of dopamine and that this property is responsible for the production of dystonia.

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