Comparison of the Green scale versus magnitude estimation for taste perception

The Green scale is a new psychophysical method that is simple for subjects to use, but its relation with magnitude estimation has yet to be fully characterized. In comparing the consistency between the Green scale and magnitude estimation, we found that the former seems to provide a psychological oral sensation measurement that is different from the latter method. A simple correction formula can be derived.

Age-related changes in the prevalence of smell/taste problems among the United States adult population. Results of the 1994 disability supplement to the National Health Interview Survey (NHIS)

Information about the prevalence of disorders of the chemical senses has been limited. In the late 1970s, the consensus among experts convened by the National Institutes of Health (NIH) was that more than 2 million adults in the United States had a disorder of smell or taste. A large, nonrandom survey conducted by the National Geographic Society in 1987 found that 1% of their 1.2 million respondents could not smell 3 or more of 6 odorants using a 'scratch and sniff' test. Age was an important factor, with a decline beginning in the second decade of life. No comparable data have been available for taste, although it has been suggested that the sense of taste remains more robust with age. The National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, began collaborating with the National Center for Health Statistics (NCHS) in 1993 to acquire information on the prevalence of smell/taste problems using the Disability Supplement to the National Health Interview Survey (NHIS). This survey was administered to approximately 42,000 randomly-selected households (representing about 80,000 adults over 18 years of age) in 1994. Adjusted national estimates derived from this survey showed a prevalence of 2.7 million (1.4%) U.S. adults with an olfactory problem. Also, 1.1 million (0.6%) adults reported a gustatory problem. When smell or taste problems were combined, 3.2 million (1.65%) adults indicated a chronic chemosensory problem. The prevalence rates increased exponentially with age. Almost 40% with a chemosensory problem (1.5 million) were 65 years of age or greater. In a multivariate analysis, the individual's overall health status, other sensory impairments, functional limitations (including difficulty standing or bending), depression, phobia, and several other health-related characteristics were associated with an increase in the rate of chemosensory disorders.

Surgical treatment of epilepsy in tuberous sclerosis: strategies and results in 18 patients

BACKGROUND

Seizures in patients with tuberous sclerosis complex (TSC) are often intractable to antiepileptic medications and searching investigation may provide evidence that surgical treatment can be considered.

OBJECTIVE

To review the results of investigation and surgical therapy, a treatment modality not generally considered in patients with medically refractory seizures and TSC.

METHODS

We report 18 patients (9 male) with TSC who underwent surgical treatment of medically refractory epilepsy. Twelve patients had a well-localized epileptogenic lesion and were treated by lesionectomy or focal resection. Resections were: 7 frontal, 4 temporal, 1 frontotemporal, 1 occipital, and 1 frontoparietal. Four patients underwent more than one operation. Six patients had corpus callosotomy (CC).

RESULTS

Follow-up ranged from 1 month to 47 years. Outcome of the patients treated by resection was excellent in 7 (5 were seizure-free and 2 had auras only), good in 1, fair in 3, and 1 was lost to follow-up. Best outcome was obtained in patients who had focal seizures and good imaging and EEG correlation, although they might have multiple seizure types, other imaging abnormalities, and multifocal or generalized EEG findings. When there was no such correlation, CC was found to be an option as five patients had at least some improvement and only one showed no change.

CONCLUSION

Surgical treatment of patients with TSC and intractable epilepsy is most effective when a single tuber or epileptogenic area can be identified as the source of seizures and resected. This may be possible even when other tubers or diffuse EEG abnormalities are present. In patients with unlocalizable epileptic abnormalities, palliation may be obtained by CC.

Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study

CONTEXT

Studies have demonstrated strong associations between the prone sleep position (on the stomach) and sudden infant death syndrome (SIDS). In 1992, the American Academy of Pediatrics recommended that infants be placed to sleep laterally (on their side) or supine (on their back) to reduce SIDS risk, and in 1994, the national public education campaign "Back to Sleep" was launched.

OBJECTIVE

To determine the typical sleep position of infants younger than 8 months in the United States, the changes that occurred after these recommendations, and the factors associated with the placement of infants prone or supine.

DESIGN

Annual nationally representative telephone surveys.

SETTING

The 48 contiguous states of the United States.

PARTICIPANTS

Nighttime caregivers of infants born within the last 7 months between 1992 and 1996. Approximately 1000 interviews were conducted per year.

MAIN OUTCOME MEASURES

The position the infant was usually placed in for sleep, and the position the infant was most commonly found in when checked during the night's sleep.

RESULTS

Ninety-seven percent of respondents in each wave of the survey usually placed their infant to sleep in a specific position. Infants were placed in the prone position by 70% of caregivers in 1992, prior to the campaign, but only 24% in 1996. Supine and lateral placements increased during this time period, from 13% in 1992 to 35% in 1996 and from 15% in 1992 to 39% in 1996, respectively. Significant predictors of prone placement included maternal race reported as black (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.68-3.26), mother's age 20 to 29 years (OR, 1.28; 95% CI, 1.09-1.50), region reported as the mid-Atlantic (OR, 1.41; 95% CI, 1.12-1.78) or southern states (OR, 1.47; 95% CI, 1.22-1.70), mothers with a previous child (OR, 1.68; 95% CI, 1.43-1.97), and infants younger than 8 weeks (OR, 0.63; 95% CI, 0.46-0.85). Infants aged 8 to 15 weeks were significantly more likely to be placed nonprone over time compared with the other age groups. Most of the risk factors for prone were significantly related in the opposite direction to supine placement.

CONCLUSIONS

The prevalence of infants placed in the prone sleep position declined by 66% between 1992 and 1996. Although causality cannot be proved, SIDS rates declined approximately 38% during this period. To achieve further reduction in prone sleeping, efforts to promote the supine sleep position should be aimed at groups at high risk for prone placement.

Neurodevelopmental outcome of small-for-gestational-age infants

Despite many methodological difficulties, studies evaluating the relationship between being small for gestational age (SGA) at birth and various measures of adverse neurologic outcome generally show significant associations. Nevertheless, cerebral palsy is rarely found in SGA infants. Minimal neurologic dysfunction is more commonly seen in males and lower socioeconomic SGA children, and is often associated with attention deficits, hyperactivity, clumsiness, and poor school performance. Vision and hearing are generally not disturbed in SGA infants.

Intractable seizure disorder associated with chronic herpes infection. HSV1 detection in tissue by the polymerase chain reaction

We describe the pathological findings and report the detection of herpes simplex virus 1 (HSV1) in the brain in three patients who presented with intractable seizures. All three patients had a previous history of HSV1 encephalitis and went on to develop a medically refractory seizure disorder necessitating surgical intervention. HSV1 encephalitis was clinically diagnosed and treated at 6 months, 3 years, and 7 months and surgical resection was done at 8.5 years, 6 years, and 3 years, in cases 1, 2 and 3, respectively. Pathological examination revealed chronic encephalitis in all three cases, with microglial nodules, intraparenchymal, perivascular and meningeal lymphocytic infiltrates, and gliosis. While immunohistochemical and ultrastructural studies were negative for viral pathogens, polymerase chain reaction (PCR) analysis revealed HSV1 genome. These cases represent examples of chronic herpes encephalitis and seizure disorder with presence of viral genome in the brain long after the initial episode of treated herpes encephalitis.

Relation between very low birth weight and developmental delay among preschool children without disabilities

The authors examined the relation between very low birth weight (VLBW: < 1,500 g) and possible developmental delay (DELAY) in the absence of frank developmental disability among young children. The prevalence of DELAY in a population-based cohort (Missouri resident births born from December 1989 through March 1991) of singleton VLBW children (n = 367) was compared with the prevalence of DELAY among both moderately low birth weight (MLBW: 1,500-2,499 g; n = 553) and normal birth weight (NBW: > or = 2,500 g; n = 555) singleton control children. DELAY was defined by nine measures of performance on the Denver Developmental Screening Test II at a median adjusted age of 15 months (range: 9-34 months). Subjects were asymptomatic for disabling conditions at developmental follow-up. Apparently well VLBW children were consistently at greater risk for both moderate and severe measures of DELAY and for DELAY across four functional areas than were either the MLBW (adjusted odds ratios: 1.4-2.7) or NBW children (adjusted odds ratios: 2.1-6.3). The greatest prevalence of DELAY tended to be among appropriate-for-gestational age VLBW children who were also the most premature. This study supports developmental follow-up of nondisabled VLBW children because of the significantly elevated risk for DELAY among apparently normal infants.

Intracranial and spinal metastases from a ganglioglioma with unusual cytogenetic abnormalities in a patient with complex partial seizures

We describe an unusual clinical presentation of a ganglioglioma in a patient with complex partial seizures. The patient underwent a right temporal lobectomy with subtotal tumor resection at age 15 years, followed by a complete resection 1 year later. Follow-up MRI scan a year later documented recurrence and leptomeningeal dissemination. Another biopsy was performed. Pathological examination revealed similar histology in all three resections, with a ganglioglioma showing no evidence of anaplasia. The tumor exhibited a number of karyotypic abnormalities, notably, a paracentric inversion of chromosome 7. In summary, despite lacking anaplastic features by conventional histological criteria, this ganglioglioma showed an unsusual karyotype and demonstrated radiological evidence of widespread dissemination.

Moyamoya disease and syndrome

Moyamoya disease was first described by Suzuki in 1963. The surgical management of Moyamoya disease began in the mid 1970s. At our institution we began operating on Moyamoya disease in 1979 and between 1979 and 1995 we have treated 30 children with Moyamoya disease and Moyamoya syndrome. Of these 21 children have an excellent outcome. Two children continued to have symptoms and both responded to an encephalo-myo-synangiosis (EMS) procedure, five children had a good outcome but are left with a significant neurologic deficit, one child remains in a poor state and one child had an excellent outcome but then died of his Fanconi's anemia 7 years after his encephalo-duro-arterio-synangiosis (EDAS) procedure.

Sudden infant death syndrome and smoking in the United States and Sweden

The association between sudden infant death syndrome (SIDS) and maternal smoking was compared between the United States and Sweden-two countries with different health care and social support programs and degrees of sociocultural heterogeneity. For 1990-1991 among the five US race/ethnic groups studied, SIDS rates ranged from a high of 3.0 infant deaths per 1,000 live births for American Indians to a low of 0.8 for Hispanics and Asian and Pacific Islanders. The SIDS rate for Sweden (using 1983-1992 data) was 0.9. The strong association between maternal smoking and SIDS persisted after controlling for maternal age and live birth order. Adjusted odds ratios ranged from 1.6 to 2.5 for mothers who smoked 1-9 cigarettes per day during pregnancy (compared with nonsmokers) and from 2.3 to 3.8 for mothers who smoked 10 or more cigarettes per day during pregnancy. Although birth weight had a strong independent effect on SIDS, the addition of birth weight to the models lowered the odds ratios for maternal smoking only slightly, suggesting that the effect of smoking on SIDS is not mediated through birth weight. SIDS rates increased with the amount smoked for all US race/ethnic groups and for Sweden. Smoking is one of the most important preventable risk factors for SIDS, and smoking prevention/intervention programs have the potential to substantially lower SIDS rates in the United States and Sweden and presumably elsewhere as well.

Low prenatal weight gain among low-income women: what are the risk factors?

BACKGROUND

Although a large body of evidence suggests that prenatal weight gain is an important determinant of fetal growth, 23 to 38 percent of nonobese women have low prenatal weight gain. Determination of potential risk factors for low gain is essential to develop targeted intervention programs. This study examined the association of maternal sociodemographic, lifestyle, and reproductive characteristics with the actual occurrence of low gain among 536 black and 270 white low-income, nonobese women.

METHODS

Sociodemographic, pregnancy wantedness, reproductive, and anthropometric data were obtained by interview during the first prenatal visit. A 72-item questionnaire, administered at 24 to 26 weeks' gestation, assessed residential and household characteristics, housing characteristics, income, transportation, physical activity, employment, and institutional support. Variables associated with low gain in bivariate analyses were included in logistic regression analysis to determine the adjusted odds ratios for low gain.

RESULTS

Three characteristics were associated with increased adjusted odds ratios for low prenatal weight gain among black women: having a mistimed or unwanted pregnancy, caring for more than one preschool child at home, and not using own car for errands. One characteristic, working more than 40 hours per week when employed, was associated with low gain among white women.

CONCLUSION

Although these preliminary findings require additional confirmation, they suggest that a variety of sociodemographic and lifestyle features deserve investigations that target the identification and characterization of risk factors for low prenatal weight gain.

Management and outcomes of posterior fossa subdural hematomas in neonates

OBJECTIVE

To review and analyze a contemporary series of 15 neonates who were treated for posterior fossa subdural hematomas (PFSDHs) during the era of computed tomography and magnetic resonance imaging.

METHODS

A retrospective chart review identified all neonates with PFSDHs for whom neurosurgical consultations were obtained for treatment planning.

RESULTS

There were nine male and six female patients. The mean gestational age was 39 weeks. Nine of the 15 mothers of the patients were primiparous. Instrument-assisted delivery (forceps and/or vacuum extractor) was undertaken for seven patients. The mean birth weight of the infants was 3165 g (range, 2160-3930 g). The mean 5-minute Apgar score was 7.5. Symptoms of PFSDH developed within the first 24 hours of life in 13 neonates. The predominant symptoms and signs were failure to thrive, irritability, seizures, apnea, and bradycardia. Lumbar punctures to rule out central nervous system sepsis were performed in six neonates. Hemograms revealed that six neonates were anemic with low hemoglobins, five had low platelets, and four had abnormal prothrombin and/or partial thromboplastin times at the time of diagnosis. Computed tomography established the diagnosis of PFSDH in all cases. Magnetic resonance imaging was performed for two neonates. The median time to diagnosis by imaging studies was 10 hours after birth. Surgical evacuation of the PFSDHs was performed in eight neonates. Seven neonates were followed conservatively with serial imaging studies. There was no mortality in either treatment group. Follow-up ranged from 2 to 10 years, with a mean of 4.5 years. Functional outcome assessment revealed that seven neonates were neurodevelopmentally normal, three were mildly delayed, two were moderately delayed, and three were profoundly delayed. In addition to traumatic causes of the PFSDHs, three neonates were observed to have coagulation disturbances at birth and one was observed at follow-up to have a posterior fossa medulloblastoma that had bled at birth.

CONCLUSION

PFSDHs are rare but important lesions to diagnose early in the neonatal period. Surgery can be life-saving when performed in a timely manner for signs and symptoms of brain stem dysfunction. A search for an underlying cause predisposing to a PFSDH may, on occasion, reveal a coagulation disturbance or a neoplasm that will require additional therapeutic considerations.

Optic chiasmatic-hypothalamic glioma

Optic chiasmatic-hypothalamic gliomas (OCHGs) have been considered benign tumors and self-limiting in growth potential because of their histological appearance. Unfortunately, most clinical series have reported significant morbidity and mortality especially with the more extensive, posteriorly positioned tumors. The biological behavior of OCHGs is age-dependent, with patients younger than five years and older than 20 years typically having tumors that exhibit aggressive growth. There are no specific pathological features to help differentiate the clinical behavior of such tumors. The emergence of modern imaging techniques, including magnetic resonance imaging (MRI), has facilitated the monitoring of the natural history of the disease and the determination of the effects of therapy. Most patients with OCHGs survive for many years. While the natural history of an OCHG for any individual may be indeterminate, enough data are now available from large series to make recommendations for treatment. Our current treatment policy for patients with OCHGs in the context of NF-I without visual failure is a conservative one involving CSF shunting for hydrocephalus if present and medical therapy for endocrinologic dysfunction. Patients with or without NF-I with visual deterioration or progressive neurological deficits and a rapidly expanding suprasellar mass lesion are treated surgically. After tumor resection, patients whose vision is significantly compromised or who show progression of their disease on serial neuroimaging scans receive chemotherapy. If chemotherapy proves ineffective in disease stabilization, then considerations of radiation therapy are given to children over five years old.

Combined utility of functional MRI, cortical mapping, and frameless stereotaxy in the resection of lesions in eloquent areas of brain in children

We studied 16 children with lesions in the eloquent brain to determine if the amalgamation of information from functional magnetic resonance imaging (fMRI), frameless stereotaxy, and direct cortical mapping and recording could facilitate the excision of these lesions while minimizing potential neurological deficits. The mean age of the children was 10 years. Fourteen children presented with seizures. All lesions were located in or near eloquent cerebral cortex. fMRI was successful in all patients in delineating the relationship between the lesion and regions of task-activated cortex. The ISG wand was utilized in all cases for scalp and bone flap placement, and for intraoperative localization of the lesion. Direct cortical stimulation or recording of phase reversals with somatosensory evoked potentials helped delineate the central sulcus and language cortex in patients with lesions near the motor or language cortex. Intraoperative electrocorticography (ECoG) was utilized in all patients who presented with seizures to guide the extent of resection of the epileptiform cortex. Ten children had benign cerebral neoplasms, nine of which were totally resected. The other diagnoses included vascular malformations, Sturge-Weber, tuberous sclerosis, Rasmussen's encephalitis, and primitive neuroectodermal tumor. Only 1 patient with a left Rolandic AVM developed a new neurological deficit postoperatively. Thirteen of fourteen patients who presented with seizure disorders were rendered either seizure free or improved in terms of seizure control postoperatively. Follow-up has ranged from 12 to 18 months, with a mean follow-up of 15 months. We conclude that the techniques of fMRI, frameless stereotaxy, direct cortical stimulation and recording can be utilized in sequence to accurately localize intracerebral lesions in eloquent brain, and to reduce the morbidity of resecting these lesions in children.

Abbreviated scale for the assessment of psychosocial status in pregnancy: development and evaluation

BACKGROUND

Data from five existing psychosocial scales were used to develop an abbreviated scale for the assessment of psychosocial status during pregnancy.

METHODS

Scales were self-administered by 842 black and 381 white low-income multiparous women at risk for poor pregnancy outcome. Trait anxiety (Speilberger), self-esteem (Rosenberg), mastery (Pearlin), and depression (CES-D) were assessed at 24-26 weeks' gestation; subjective stress (Schar) was assessed at 30-32 weeks' gestation. The 59 pooled items were examined for redundancy and the discernment of primary factors using principal factor analysis. Regression analysis was used to determine if the resulting abbreviated scale (28 items) would provide information similar to that obtained with the 59 item pool (full scale) in predicting gestational age (GA), birth weight (BW), fetal growth restriction (FGR), and preterm delivery (PTD).

RESULTS

The abbreviated scale was highly correlated (r = 0.97) with the 59-item pool and the six factors isolated were generally compatible with the major characteristics assessed by the five original scales. The distribution of FGR and PTD by scale quartile was similar for the abbreviated and the combined scales. Logistic regression analysis of scores for all women revealed that poor (high) scores on both the full (p = 0.0151) and the abbreviated scales (p = 0.0131) were positively associated with FGR, but not with PTD. In linear regression analysis poor (high) scores on both the full (p = 0.0024) and the abbreviated scale (p = 0.0019) were negatively related to BW, but not to GA. When data for black and white women were examined separately, the two scales provided comparable information.

CONCLUSIONS

The abbreviated psychosocial scale provided information similar to that obtained with 59 pooled items in predicting GA, BW, FGR, and PTD.

Serum concentrations of zinc, folate, vitamins A and E, and proteins, and their relationships to pregnancy outcome

OBJECTIVE

To review the relationships between various laboratory measures relating to nutrition and pregnancy outcome. The data were obtained during the investigation entitled "Successive small-for-gestational-age births study".

METHODS

A total of 289 pregnant women of the 1545 who participated in the study between 1986 and 1988 in Birmingham, Alabama, USA. The following determinations were done using the serum samples obtained at 18 and 30 weeks of gestation: zinc, folate, vitamins A and E, and proteins (alpha-2-macroglobulin, retinol-binding protein, prealbumin, and albumin). These laboratory values were correlated with various measures of pregnancy outcome including the incidence of fetal-growth retardation and maternal infections during the perinatal period and birth weight and Apgar score of infants.

RESULTS

Serum folate concentrations showed positive relationships with the incidence of fetal-growth retardation as well as birth weight of infants, and alpha-2-macroglobulin was negatively correlated with birth weight. These relationships were significant after adjusting for factors previously known to affect the birth weight of infants. The concentrations of serum zinc, vitamins A and E, and proteins did not show significant correlation with measures of pregnancy outcome.

CONCLUSION

Among the laboratory measures evaluated in this study, serum folate and alpha-2-macroglobulin concentrations correlated with pregnancy outcome. Further research is warranted to investigate the mechanism(s) of the relationship between serum alpha-2-macroglobulin and birth weight of infants.

Body proportions and early neonatal morbidity in small-for-gestational-age infants of successive births

BACKGROUND

We wanted to examine if infants who were small for gestational age (SGA) at term had increased perinatal mortality or morbidity compared to non-SGA infants, and if this could be related to the infant's body proportions, or to whether the mother previously had delivered a low-birthweight infant ("repeater") or not ("non-repeater").

METHODS

From a cohort of 5722 para 1 and para 2 women, we compared perinatal mortality in 541 SGA (birthweight < 10th percentile) and 4737 non-SGA infants. From the same cohort, early neonatal morbidity was studied in 368 SGA and 462 control infants without congenital malformations.

RESULTS

SGA infants had a 6.4 (95% CI: 2.6-15.7) higher risk of perinatal death than controls, but when infants who died with congenital malformations were excluded, this risk was not significantly increased. SGA infants were more often transferred to an intensive care unit than controls (1.7, 95% CI: 1.0-2.9). Among SGA births, infants with asymmetric body proportions (i.e. low ponderal index) more often had symptoms in the neonatal period (RR: 2.5; 95% CI: 1.4-4.3) and were more often transferred to an intensive care unit (3.4; 95% CI: 1.6-7.4) than symmetric SGA infants, whereas there were no differences between SGA infants of repeaters and non-repeaters.

CONCLUSIONS

We found that SGA infants had higher perinatal mortality than controls, but this was due to a higher prevalence of congenital malformations. Among SGA infants without malformations, our results indicated increased neonatal morbidity in infants with asymmetric body proportions.

Maternal serum concentrations of human placental lactogen, estradiol and pregnancy specific beta 1-glycoprotein and fetal growth retardation

BACKGROUND

To determine if maternal serum levels of human placental lactogen (hPL), estradiol, and pregnancy-specific beta 1-glycoprotein (SP1) measured at approximately 18 weeks' gestation were associated with fetal growth retardation (FGR) in infants delivered at or after 37 weeks.

METHODS

Serum samples were obtained at a mean of 18 weeks' gestational age from 200 multiparous women with risk factors for FGR. Maternal serum concentrations of hPL, estradiol and SP1 were correlated with FGR.

RESULTS

A total of 59 (29.5%) of the 200 infants were diagnosed postnatally with FGR. There were no significant differences in the prevalence of FGR among the lowest quartiles of estradiol, hPL or SP1. However, pregnancies in the highest quartile of estradiol levels at 18 weeks' (> 580 pg/ml) were associated with a significantly lower risk of FGR than those in the lower three quartiles, 8 out of 50 (16%) vs 51 of 150 (34%) (p = < 0.05). The prevalence of FGR associated with the highest quartile of hPL (> 1.73 micrograms/ml) was 12.2% compared to 35% in the lower three quartiles (p = 0.025) and the prevalence of FGR associated with the highest quartile of SP1 (> 43 ng/ml) was 14% compared to 34.7% in the lower three quartiles (p = 0.018). Only one out of 21 infants (4.5%) whose mothers had each value in the highest quartile of hPL, estradiol, and SP1 was diagnosed with FGR compared to 58 out of 178 (32.6%) of the remaining infants (p = 0.007).

CONCLUSIONS

In pregnancies of women at high risk for FGR, higher levels of estradiol, hPL, and SP1 at 18 weeks are associated with a decreased prevalence of FGR. This finding indicates that high levels of these hormones are related to a lower risk of FGR, but that low levels do not predict FGR.

Positive epileptiform discharges in children with neuronal migration disorders

Most epileptiform abnormalities show a negative polarity on EEG. Focal positive spike waves have rarely been identified in seizure disorders and are generally associated with physiological and neurological impairment. Results of EEG, computed tomography, MRI, and pathologic studies of 15 children with focal neuronal migration disorders who underwent surgery for refractory localization-related epilepsy were compared to examine the association between positive discharges and other findings. Subjects were studied both ictally and interictally by scalp EEG with the International 10-20 system and zygomatic or sphenoidal electrodes, and video EEG telemetry. The 5 children with positive discharges were significantly more likely to develop hemiparesis during the preoperative period (P < or = .025). Correlations were observed between positive discharges and lesions apparent on MRI situated around the rolandic fissure (P < or = .025). Children with positive discharges had a significantly less favorable outcome after surgical treatment (P < or = .025). Positive epilepti-form discharges in children with neuronal migration disorders may signal a more dysfunctional cortex leading to a focal neurological deficit or a more extended lesion than is detected on MRI. This would explain the less favorable outcome of seizures after surgery, since the epileptogenic areas and neuronal migration lesions cannot be completely resected.