LLITEKS 1 0 I H t LDITOK
Epilepsy in Nigerian Children SIR-I was interested to read of the high incidence of temporal lobe epilepsy in the EFG series of Nigerian children reported by Osuntokun et ul. ( D M C N . 16, 659). In the Ileslia area of Western State. Nigeria, febrile convulsions are among the most common paediatric emergencies. the pyrexia most often being caused by malaria. Many of the children have to travel considerable distances for medical help, with the result that the convulsion may have lasted for an hour or more before it is terminated. In this situation. one would expect a high incidence of temporal lobe damage.’ The importance of regular malaria prophylaxis in this vulnerable age-group should be emphasised. There is also a pressing case for permitting village-based medical auxiliaries or midwives to administer a stat dose of intramuscular paraldehyde o r diazepam t o any convulsing child before he starts off on a long journey to the nearest hospital. K. B. MCGCICKEN (Late of Wesley Guild Hospital, Paediatric Department, Ilesha, Nigeria) Royal Albert Edward Infirmary. Wigan, Lancs. WNI 2”. I . Ounsted. C. (1967) ’Temparal lobe epilepsy: the prohlenls of aetiology and prophylaNis.’ J o r r r ~ ~ u//ti, /~/ l?o).fr/ C o / l r ~ of e Ph,,sicinn.s, 1, 273.
The Asymmetrical Tonic Neck Reflex SIR-This letter is somewhat late, but keeping up with current journals seems to be a labor of Sisyphus. In the article by Parr et ul. ( D M C N , 16, 329), a subject was touched on which in general has been ignored by most pediatricians. I became interested at one time in the asymmetrical tonic neck reflex and noted the direction in which the head turned when supine in all my newborn patients, and later correlated this with hand, eye and foot preference. 1 also did some anthropometric measurements to determine half-face size and occipital flattening to ascertain whether there was a correlation between these measurements and the preferences. Unfortunately, my data leave much to be desired and are not suitable for publication. However, in my opinion the child’s tonic neck reflex is to the same side a s that of the preferred eye. and the face is narrower on that side. There was also evidence that flattening of the occiput occurred on the side to which the head is turned. If these observations are valid. then eye preference antedates hand preference and may be the best guide to the determination of cortical dominance until direct measures are available. LEONOt:I-l~ll\iGtR,J K . Director. Pediatric Epilepsy Clinic; Associate Clinical Professor of Pediatrics; University of California. Los Angeles.
Hearing Loss After H . influenzuc Meningitis SIR-In the October 1974 issue of D M C N , I noted the article by Gamstorp and Klockhotf’ on deafness following H . iuflue,rzne meningitis, in which the authors raised the possibility of an increased frequency of this sequela with ampicillin therapy. We have certainly seen a number of patients with eighth-nerve deficit, including both deafness and vestibular loss, after Hrtirophilus meningitis treated with ampicillin. For another reason, I reviewed the cases of Heniopl7ilus meningitis in this hospital between I19
Epilepsy in Nigerian Children SIR-I was interested to read of the high incidence of temporal lobe epilepsy in the EFG series of Nigerian children reported by Osuntokun et ul. ( D M C N . 16, 659). In the Ileslia area of Western State. Nigeria, febrile convulsions are among the most common paediatric emergencies. the pyrexia most often being caused by malaria. Many of the children have to travel considerable distances for medical help, with the result that the convulsion may have lasted for an hour or more before it is terminated. In this situation. one would expect a high incidence of temporal lobe damage.’ The importance of regular malaria prophylaxis in this vulnerable age-group should be emphasised. There is also a pressing case for permitting village-based medical auxiliaries or midwives to administer a stat dose of intramuscular paraldehyde o r diazepam t o any convulsing child before he starts off on a long journey to the nearest hospital. K. B. MCGCICKEN (Late of Wesley Guild Hospital, Paediatric Department, Ilesha, Nigeria) Royal Albert Edward Infirmary. Wigan, Lancs. WNI 2”. I . Ounsted. C. (1967) ’Temparal lobe epilepsy: the prohlenls of aetiology and prophylaNis.’ J o r r r ~ ~ u//ti, /~/ l?o).fr/ C o / l r ~ of e Ph,,sicinn.s, 1, 273.
The Asymmetrical Tonic Neck Reflex SIR-This letter is somewhat late, but keeping up with current journals seems to be a labor of Sisyphus. In the article by Parr et ul. ( D M C N , 16, 329), a subject was touched on which in general has been ignored by most pediatricians. I became interested at one time in the asymmetrical tonic neck reflex and noted the direction in which the head turned when supine in all my newborn patients, and later correlated this with hand, eye and foot preference. 1 also did some anthropometric measurements to determine half-face size and occipital flattening to ascertain whether there was a correlation between these measurements and the preferences. Unfortunately, my data leave much to be desired and are not suitable for publication. However, in my opinion the child’s tonic neck reflex is to the same side a s that of the preferred eye. and the face is narrower on that side. There was also evidence that flattening of the occiput occurred on the side to which the head is turned. If these observations are valid. then eye preference antedates hand preference and may be the best guide to the determination of cortical dominance until direct measures are available. LEONOt:I-l~ll\iGtR,J K . Director. Pediatric Epilepsy Clinic; Associate Clinical Professor of Pediatrics; University of California. Los Angeles.
Hearing Loss After H . influenzuc Meningitis SIR-In the October 1974 issue of D M C N , I noted the article by Gamstorp and Klockhotf’ on deafness following H . iuflue,rzne meningitis, in which the authors raised the possibility of an increased frequency of this sequela with ampicillin therapy. We have certainly seen a number of patients with eighth-nerve deficit, including both deafness and vestibular loss, after Hrtirophilus meningitis treated with ampicillin. For another reason, I reviewed the cases of Heniopl7ilus meningitis in this hospital between I19
