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Alice is referred by her general practitioner (GP) for a paediatric neurology opinion with a history of episodes of her legs giving way. The referral letter from her GP mentions that when Alice is picked up when she has one of these episodes, she cannot control her legs, which move abnormally. Alice is seen by the registrar. Her parents' say that these episodes are occurring at a frequency of one every month, and they describe non-rhythmic jerky movements involving her legs lasting approximately 20 min. She falls and cannot walk or stand when these happen. Recovery occurs without intervention. She has experienced a total of five episodes, and they all occurred in the evening following exertion. Her consciousness is not impaired during these events, and between the episodes Alice is well. The prenatal and perinatal history are normal, and her development is in keeping with her chronological age. An interesting aspect of Alice's family history is the fact that her father had experienced similar episodes when he was 8 years old, and they had lasted until he was 13. He described episodic paroxysmal movements involving both his upper and lower limbs, and he recalled needing to sit down when these episodes occurred. He had been given the diagnosis of Sydenham's chorea by his GP. Alice's head circumference and neurological examination are normal. The paediatric registrar discusses Alice with the neurology consultant, and given the history of Alice's father having similar episodes in childhood, they consider the possibility of a familial movement disorder such as a ‘Benign hereditary chorea.’ Since Alice is clinically well, the decision is made not to investigate further at that point but to keep her under review. The neurologist suggests a video recording of the event should it happen again. ### Comment Chorea is characterised by frequent, random, unpredictable …

Introduction Infectious and immune-mediated encephalitides are important but under-recognised causes of morbidity and mortality in childhood, with a 7% death rate and up to 50% morbidity after prolonged follow-up. There is a theoretical basis for ameliorating the immune response with intravenous immunoglobulin (IVIG), which is supported by empirical evidence of a beneficial response following its use in the treatment of viral and autoimmune encephalitis. In immune-mediated encephalitis, IVIG is often used after a delay (by weeks in some cases), while diagnosis is confirmed. Wider use of IVIG in infectious encephalitis and earlier use in immune-mediated encephalitis could improve outcomes for these conditions. We describe the protocol for the first ever randomised control trial of IVIG treatment for children with all-cause encephalitis. Methods and analysis 308 children (6 months to 16 years) with a diagnosis of acute/subacute encephalitis will be recruited in ∼30 UK hospitals and randomised to receive 2 doses (1 g/kg/dose) of either IVIG or matching placebo, in addition to standard treatment. Recruitment will be over a 42-month period and follow-up of each participant will be for 12 months post randomisation. The primary outcome is ‘good recovery’ (score of 2 or lower on the Glasgow Outcome Score Extended—paediatric version), at 12 months after randomisation. Additional secondary neurological measures will be collected at 4–6 weeks after discharge from acute care and at 6 and 12 months after randomisation. Safety, radiological, other autoimmune and tertiary outcomes will also be assessed. Ethics and dissemination This trial has been approved by the UK National Research Ethics committee (South Central—Oxford A; REC 14/SC/1416). Current protocol: V4.0 (10/03/2016). The findings will be presented at national and international meetings and conferences and published in peer-reviewed journals. Trial registration numbers NCT02308982, EudraCT201400299735 and ISRCTN15791925; Pre-results.

The case is described of a boy with the Kleine-Levin syndrome in whom prominent behavioural disturbances and the initial absence of a clear cyclical pattern obscured the diagnosis. Treatment with lithium was effective.

Approximately 10% of children with epilepsy have absence epilepsy syndromes.1 The diagnosis is confirmed by recording events during a standard EEG recording synchronised with video.2 However, non-epileptic absence-like behaviour is common in children, and although there may be clinical pointers to non-epileptic behaviours, an EEG is often requested.3 To describe the EEG (synchronised with video) results in children …

To look at the outcome of the routine video EEG (vEEG) wake and sleep records on children referred following a single unprovoked afebrile seizure. We examined all the vEEGs that were undertaken in a regional paediatric neurophysiology department in Oxford, following a single unprovoked seizure over a 1-year period (2008–2009), several years after National Institute for Health and Clinical Excellence (NICE)1 guidelines for the management of …

Editor,—A 14 week old boy was referred for neurological review with a 24 hour history of an isolated, left sided, lower motor neuron facial nerve palsy. Twelve days earlier, he had presented with fever, irritability, and a macular rash. A septic screen was negative, including normal cerebrospinal fluid indices. The fever settled on day 5, the rash improved, and …