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Unlabelled: Do children who remain in remission with epilepsy after withdrawal of anticonvulsive therapy still exhibit a different behaviour and performance-related abilities compared to healthy children? It was the aim of this study to investigate whether these children showed deviating psychiatric behaviour and/or neuropsychological function deficits as compared with a healthy control group and with children following occasional seizures which had never been treated. The study comprised 39 children with epilepsy after withdrawal of anticonvulsive therapy, 37 children with occasional seizures, and 39 matched healthy control children who were tested with regard to psychiatric and neuropsychological criteria. The patients were aged 6-15 years; 28 had a primarily generalised epilepsy, and 11 had a focal epilepsy. The patients remained free from seizures for more than 1 year. Psychiatric testing comprised the Child Behavior Checklist by Achenbach and Edelbrock and the Mannheim Parent Interview. Neuropsychological testing included non-verbal intelligence, visual perception, short-term memory and learning ability, arithmetics, movement coordination and motor skills, fine motor skills and verbal functions. After withdrawal from anticonvulsive therapy, the children with epilepsy did not exhibit any psychiatric disturbances, whereas those with occasional seizures frequently showed behaviour problems. After withdrawal from anticonvulsive therapy, no neuropsychological deficits were found in the children with epilepsy as compared to those with occasional seizures or to healthy children. Risk factors for poorer test results were first seizures occurring before the age of 3 years, delayed development, and neonatal problems., Conclusion: Children with epilepsy who remained without relapse after withdrawal from the anticonvulsive therapy did not show any psychiatric abnormalities and their performance was comparable to that of healthy control children, provided no risk factors were present.

We report on 10 patients between 3 and 18 years of age who had been treated in the neonatal and postneonatal period for hydrocephalus of various causes with a ventriculo-atrial or ventriculo-peritoneal shunt. Between the age of 2 and 17 years these children suffered from recurrent attacks of headache, vomiting bradycardia and lethargy suggesting shunt-obstruction. 8 children showed slowing of electrical activity in their EEG, 4 had papilledema on fundoscopy. Splayed sutures were found in one child by skull x-ray. In all the above cases the CT-headscans assessed by radiologists showed no evidence of shunt-obstruction. Only on direct comparison with previous CT-scans we were able to detect minimally dilated ventricles in 6 children. In all cases conservative treatment failed. Symptoms only ceased after surgical shunt-revision. In all children treated with shunts headache, vomiting and vegetative symptoms must be considered as signs of shunt-obstruction until proved otherwise. A negative CT-scan done while symptoms are present cannot rule out raised intracranial pressure. Only by direct comparison with previous CT-scans carried out during an asymptomatic period a minor dilatation of the ventricles can often be detected. This should be taken as a sign of shunt-obstruction.