The antiepileptic effect of vigabatrin in adults has been demonstrated in a number of controlled studies. In children, the effect of vigabatrin has been investigated only to a limited extent. In order to assess the long-term effect and safety of vigabatrin in patients with severe epilepsy, an open, add-on, dose-ranging study was initiated. To date, 27 children with partial epilepsy, two with generalized epilepsy, two with Lennox-Gastaut syndrome, and one with nonclassifiable epilepsy have been enrolled in the trial. Fifty-four percent of patients have experienced a greater than 50% reduction in seizure frequency, and four patients have become seizure free. A significant reduction in seizures was noted across the patient population, although patients who were recorded as seizure free at 3 and 6 months did suffer some recurrence of seizures. However, when seizures recurred, they did so at much lower frequency than recorded at the start of the study. Thirteen patients (39%) reported adverse events attributable to vigabatrin; one was immediately withdrawn from the study, and six had their vigabatrin dose reduced. No physiologic effects were noted on normal growth or clinical physical examination. ( J Child Neurol 1991;6(Suppl):2S38-2S44).he neurotransmitter y-aminobutyric acid (GABA) is broken down by the enzyme GABA aminotransferase. Vigabatrin (y-vinyl-GABA) is a specific and irreversible inhibitor of this enzyme. Administration of vigabatrin leads to dose-related increases in the levels of GABA in brain and cerebrospinal fluid in humans. 1 Vigabatrin has been extensively evaluated as an anticonvulsant drug, and its efficacy as add-on therapy in the treatment of drug-resistant epilepsies has been confirmed in several double-blind, placebocontrolled studieS2-7 and one double-blind parallel study.8 Approximately half the patients in these studies experienced a 50% or greater reduction in seizure frequency. Efficacy appeared to be greater in adult patients with partial epilepsies. In children, it has been shown that vigabatrin is active in a wider range of seizure types, and its efficacy is not confined to partial seizures.9,10 Long-term follow-up studies in adults have demonstrated good tolerability and continued efficacy for periods of up to 4 years,11 but few such studies have been carried out in children. This study assesses the long-term effect, tolerability, and safety of vigabatrin in children with intractable epilepsy. Materials and Methods Study DesignThis was an open, add-on, dose-ranging study. Patients were recruited consecutively provided they fulfilled the entry criteria, ie, they were regular attenders at the study center clinic, aged between 2 and 15 years, had uncontrolled epilepsy with at least four documented seizures per month, and were on at least one other antiepileptic drug but not more than three. Informed consent was obtained from parents or guardians in all cases. Vigabatrin DosingFor the first month of treatment, the initial dose of vigabatrin for patients more than 8 years of age was 2 g da...

Marya Schechtman's The Constitution of Selves presented an impressive attempt to persuade those working on personal identity to give up mainstream positions and take on a narrative view instead. More recently, she has presented new arguments with a closely related aim. She attempts to convince us to give up the view of identity as a matter of psychological continuity, using Derek Parfit's story of the "Nineteenth Century Russian" as a central example in making the case against Parfit's own view, and offers a form of narrative theory as a way out of the problem. In this paper I consider this new case, and argue that we should not be persuaded towards the narrative.

Transplant' thought-experiments, in which the cerebrum is moved from one body to another have featured in a number of recent discussions in the personal identity literature. Once taken as offering confirmation of some form of psychological continuity theory of identity, arguments from Marya Schechtman and Kathleen Wilkes have contended that this is not the case. Any such apparent support is due to a lack of detail in their description or a reliance on predictions that we are in no position to make. I argue that the case against them rests on two serious misunderstandings of the operation of thought-experiments, and that even if they do not ultimately support a psychological continuity theory, they do major damage to that theory's opponents.Section 1: The Transplant 'Transplant' thought-experiments, in which the cerebrum is moved from one body to another have featured in a number of recent discussions in the personal identity literature. Although they are different from the traditional 'body-swap' thought-experiments like the one with which Locke started the modern debate in that they envisage the part of the brain that supports distinctive psychology being transferred rather than just the psychology itself, they have usually been used in a similar role. That is, they are presented as offering confirmation to some form of psychological continuity theory of identity (PCT) which holds your continued existence as the person you are to be a matter of the persistence of your distinctive psychology, 1 rather than the persistence of the organism that is your body. But recent arguments have contended that this is not the case. Any such apparent support founders due to a lack of detail in their description, or a reliance on predictions that we are in no position to make. I wish to argue that the case against them is unsuccessful and even if they do not ultimately support a PCT, they stand to do major damage to that theory's opponents.

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