Thirty cases of spinal epidural abscess are reviewed with particular emphasis on mode of presentation and results of treatment. In spite of repeated exhortations in the literature for earlier diagnosis, the results remain unsatisfactory because many patients have progressed to severe or complete paralysis before the correct diagnosis is made and surgical treatment carried out.

Between 1964 and 1976, we have seen 197 cases of cerebral tumors in children. We have studied the frequency of each histological group of tumors, their localization, the results of the clinical investigation, their clinical manifestations and the prognosis for each group.

This study has confirmed that in children brain tumors are more frequently localized in the posterior fossa (56.4%). As in other series, tumors derived from the glia represent nearly 80% of the total. Clinically, increased intra-cranial pressure is the most frequent manifestation of posterior fossa lesion (75% of cases) while cerebellar involvement was seen in 60% of these childdren. Brain stem lesions and supratentorial tumors are more insidious in their presentation and their clinical manifestations more diversified.

The EEG appeared useful in the investigation of brain tumors and showed irregularities in 78% of our patients. However, a more specific diagnosis required more invasive techniques such as angiography, pneumoencephalography or ventriculography.

As in previous series, the mortality rate remained high in the children we have followed, particularly for some groups of tumors (glioblastoma, medulloblastoma, brain stem lesions). It is to be hoped that with the introduction of the CT Scan, the improvement of neurosurgical techniques and the use of immuno and chemotherapy, the prognosis may be improved.

Because there is biochemical evidence of decreased GABAergic function in Parkinson's disease, sodium valproate, an inhibitor of GA BA catabolism, was administered to eight Parkinsonian patients. Valproate treatment did not significantly alter any Parkinsonian feature, but tended to increase the dyskinesia in the “on-off” patients. The increased dyskinesias were not a result of altered peripheral metabolism of L-dopa. Despite obtaining high plasma levels of valproate, no consistent alteration of CSF GABA levels could be demonstrated. Thus, in these patients, an effect of valproate on GABA metabolism is unproven, and in turn, the role of GABA in Parkinsonism and dyskinesia uncertain.

The management of the pregnant epileptic requires close cooperation between the neurologist and obstetrician. To prevent complications, knowledge is required about the natural history of epilepsy during pregnancy, the possible teratogenic effects of antiepileptic drugs, and changes in their absorption, biotransformation, and excretion. Close plasma antiepileptic drug monitoring is required because of the change in the handling of antiepileptic drugs during pregnancy. The treatment of status epilepticus with intravenous phenytoin is effective. Drug interactions which may lead to toxic plasma levels of some drugs and subtherapeutic plasma levels of others should be anticipated. The risk of problems resulting from antiepileptic drug therapy during pregnancy appears to be minor, provided that proper medical supervision is available. Newer antiepileptic drugs should not be administered to the pregnant epileptic until their safety in pregnancy is fully established.

Baclofen was used in a double-blind crossover placebo-controlled trial to treat spasticity in patients with multiple sclerosis (MS). While on Baclofen, patients obtained a significant (p<0.001) reduction in spasticity compared to controls. The drug was particularly effective in alleviating flexor and extensors spasms, as well as their associated pain. Side effects were common in this study, but were usually well tolerated by the patients. The commonest side effects were sedation, nausea and vomiting. There were no changes in hepatic, renal, or hematological function in any patients. Increased weakness due to loss of spasticity for support was also a fairly common complaint. The drug seems best indicated in patients in whom spasticity is not required for support or other activities of daily living. Careful monitoring of the patient is essential for effective use of this drug.

Polysomes extracted from cultured fibroblast cells isolated from patients with Duchenne muscular dystrophy (DMD), carriers of the disease, and normal controls were used for in vitro measurement of protein synthesis in a wheat germ extract system. It was observed that polysomes from patients and carriers (seven of each aged 17 years or older) exhibited a 3-fold and a 1.5-fold decrease in the rate of protein synthesis, respectively, as compared with controls. These results are discussed with a view to developing a sensitive and easily available assay for the detection of DMD carriers.

The history of a patient with painful tonic seizures in association with multiple sclerosis is related. These seizures have been thought by most authors to be spinal in origin. This case is reported because of the localization of a supratentorial lesion, clinically and on CT scan.

This is a report of a giant cystic craniopharyngioma which escaped diagnosis for nine years in spite of seemingly thorough neuroradiological investigation, prior to the advent of the CT scan.

A case of carnitine palmityl transferase deficiency in skeletal muscle is described. The usual symptoms associated with this disease (recurrent muscle cramps or pain and pigmenturia) were not observed but sudden exposure to cold precipitate rhabdomyolysis in this patient.

A case is reported in Montreal of human cysticercosis in a 44-year-old man who emigrated from Italy in 1956. Numerous subcutaneous nodules were found throughout his body. X-ray of his thighs and chest sho wed oblong calcific densities measuring 1 x 0.5 cm in size. Examination of an excised nodule from the right biceps revealed a cysticercus larva morphologically similar to Cysticercus cellulosae although the scolex lacked hooks. On the basis of the intensity of infection, focal and generalized epileptic seizures, changes in the CSF, and well demarcated lucencies observed in brain scan, cerebral cysticercosis was considered the most likely diagnosis.