Faculty Bibliography

Amantadine HCl was given to 10 children with medically refractory seizures; other anticonvulsant medications were continued unchanged through the 12- to 16-week trial. Several patients noted improvement in control of myoclonic or atypical absence seizures. Tonic seizures were controlled in one patient, but worsened in another. Tonic-clonic and atonic seizures remained unchanged or worsened. Amantadine may be useful as an adjunctive anticonvulsant in some children with refractory atypical absence or myoclonic seizures.

Recent animal studies have indicated a possible role of opioids in epilepsy. Intraventricular opioid administration induces a prolonged nonconvulsive stuporous state characterized by epileptiform electroencephalographic patterns, and reversed by naloxone. In high doses, naloxone itself causes generalized clonic convulsions. We compared opioid-induced and naloxone-induced epileptogenic phenomena using quantitative 2-deoxyglucose autoradiography in order to define the anatomical structures involved in these two different seizure types. When opioid-induced seizures occurred, limbic structures were preferentially activated, but when naloxone-induced clonic convulsions occurred, pyramidal and extrapyramidal motor areas and some limbic structures were activated. Based on the present experiments and currently available evidence, we speculate that opioid-mediated epileptogenic phenomena are similar to those occurring during the postictal state of a fully kindled seizure, whereas naloxone-induced epileptogenic phenomena are similar to the ictal state. Therefore, simple pharmacological manipulation of endogenous opioid systems may allow selective study of ictal and postictal phenomena.

Cerebellar hemorrhage is rare in childhood, and is usually the result of trauma or a ruptured arteriovenous malformation. We report acute subarachnoid hemorrhage as the presenting manifestation of medulloblastoma and review the atypical presentation and causes of cerebellar hemorrhage in infants and children.