Free amino acids of CSF in hypoxicischemic encephalopathy

minimum follow-up of 18 months. All exhibited cutaneous manifestations of the disease (neurofibromas, 15%; axillary freckles, 35%; or cafE-au-lait spots, 100%). Ocular Lisch spots were found in 25% of patients. Major neurologic signs included seizures (10%), macrocephaly (15%), and headache (25%). Intellectual handicap (IQ: 75-90) was noticed in 50% of children older than 4. These children had learning disabilities, school performance problems, or speech abnormalities. We found no frank mental retardation and all children younger than 4 had normal psychomotor development. EEG was abnormal in 35% of patients (slow and/or asymmetric activity). Radiologic evaluation revealed bone lesions in 60% of patients (kyphoscoliosis, intraosseus cystic lesions, scalloping of cervical vertebral bodies, or cortical widening of tibia and fibula), and CNS impairment in 45% of patients (hamartomas and/or optochiasmatic gliomas). Family history was recorded in 55% of patients. We found no hypertension, no brain neoplasms, and only one child with perceptive hearing loss. We would like to point out the importance of early diagnosis for genetic counselling as well as MRI usefulness in CNS impairment search. Follow-up will provide more information about the natural course of this disease, especially during adolescence. 61. PROLONGED VIDEO-EEG MONITORING IN PEDIATRIC POPULATION Tomds Mesa, Jaime Godoy, Luis Aranda, Julia Santfn, Marisa Ocampo, and Cecilia Torrealba, Santiago, Chile

Video-EEG is essential for a proper differential diagnosis and management of epileptic or some nonepileptic events. We have used prolonged video-EEG monitoring since 1989 and we present our experience in a pediatric population. Special electrodes (sphenoidal or anterior temporal) and drug withdrawal were occasionally used. The 16-channel EEG information was analyzed by the spikes/seizure automatized detection program monitor (v.3 y 5.1). Nineteen patients underwent video-EEG monitoring for 1-7 days (mean: 3 days). The group included 11 male and 8 female patients, 1-18 years of age (mean: 11.7 years). In all of them epileptic seizure was the main admission diagnosis combined with drug refractoriness or normal previous EEG studies. Ictal episodes were recorded in most of them, from 2 to multiple (> 20), with an average of 3 per person. Four of 5 patients without ictal recorded events were monitored less than 32 hours, although interictal epileptic activity was clear in 3. We documented generalized epilepsy in 9 patients (ESES, juvenile myoclonic, Lennox-Gastaut and once alternating hemiplegia with epilepsy), focal epilepsy in 5, and noncommittal events in 3 (parasomnia, psychogenic, and lipotimia). One patient presented with gelastic seizures and behavioral episodes. Other infants have normal studies but seizures suggestive of a clinical history. This technique is of invaluable utility when used correctly, especially in refractory epilepsy or unclear events and it could help in seizure classification, ictal focalization, and epilepsy surgery evaluation. Monitoring of less than 24 hours can be misleading. 62. FREE AMINO ACIDS OF CSF IN HYPOXICISCHEMIC ENCEPHALOPATHY Jorge Rodriguez, Vifia del Mar, Chile During the first days of the newborn period free amino acids in plasma show significant changes, most of them decreasing. The

plasma/CSF ratio was studied by different authors; the majority of these studies were made after the newborn period. Most free AA are in smaller concentrations in the CSF than in plasma. An individual coefficient was described for each AA, suggesting that CSF amino acids composition also depends on nervous tissue and ependyma captation. Glutamate and related AA, including glutamine, aspartate, and "f-aminobutyric, are in higher concentrations in cerebral parenchyma than in other tissues. It was suggested that this AA plays an important role as a neurotransmitter. In mammalian cerebral cortex a decrease of adenosine triphosphate (ATP) is associated with an increase of aspartate, and a decrease of glutamate, aminobutyrate, and glutamine. It was reported that fuel deprivation causes changes in the levels of ATP and of these amino acids in brain. Asphyxia is one of the clinical conditions in which fuel deprivation is best expressed. A direct effect of asphyxia in free AA passing through the blood-CSF barrier was hypothesized by us. We studied the free AA of CSF and plasma in 8 patients with hypoxic-ischemic encephalopathy, in order to observe the variation of free AA in this condition. Preliminary results of CSF with respect to free AA demonstrate no significant differences between healthy and asphyxic newborns. The changes in cerebral tissue concentration of free AA associated with ATP decrease described in vitro, represents an attractive and comprehensive experimental model, but our study did not find additional data which would support it.

63. RISK FACTORS FOR HEADACHE Marco A. Arruda, Marcelo C. Ciciarelli, Carlos A. Bordini, and Jos6 G. Speciali, S~o Paulo, Brazil

Materials and Methods: Sixty-five children with ages ranging from 4 to 12, complaining of recurrent, chronic headache (group A), examined at the outpatient headache clinic at the Ribeirao Preto School of Medicine Hospital (Brazil), were compared according to age and sex to 65 other children with negative histories of headache (group B). The presence of children with benign paroxysmal vertigo, motion sickness (MS), cyclic vomiting, recurrent abdominal pains (RAP), recurrent fever (RF), limb pain (LP), food intolerance, grinding teeth (GT), somnambulism, sleep talking (ST), night enuresis, night terror (NT), and parental history of headache was investigated with the help of a proper inventory. Results: Meaningful statistical differences were found in the group of children with headache (group A), in relation to the control group (group B), in the following factors: MS, RAP, RF, LP, S, GT, ST, and NT. Sleep disturbances overall were present in 44.8% of the children in group A and 21.1% of the ones in group B. A parental history of chronic headache (at least one of the parents) was obtained in 100% of the children in group A and 66.1% of the children in group B. The diagnosis of migraine was made (International Headache Society's criteria [1988]) in at least one of the parents, in 95.3% of the children in group A and 52.3% of the children in B. Conclusions: (A) In our opinion, MS, RAP, RF, LP, S, GT, ST, NT, and positive parental history of headache and/or migraine, should be considered to be risk factors for headache in children; and (B) If one wishes to study the significance of these parameters for childhood migraine, it would be advisable to obtain a proper control group of children with nonmigrainous headache.

PEDIATRIC NEUROLOGY Vol.8 No. 5 359