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16 (38%). Concomitant anti-epileptic drugs were reduced in 15, and 7 are now on vigabatrin monotherapy. Better results were seen when vigabatrin treatment had been started earlier in the course of the disease-where spasms had been present for less than a year, 13 of 25 patients responded, compared with only 3 of the 17 who had had spasms for over a year. Perhaps the most striking finding was the response to vigabatrin in relation to the aetiology of IS. Amuch better effect was seen in symptomatic IS, with 11 (69%) of 16 showing complete control compared with only 5 (19%) of 26 with cryptogenic IS. This response was further confirmed in the children who also had tuberous sclerosis-7 of 8 had complete suppression of their spasms. Control seemed to be transient in 6 of the cryptogenic cases following an initial seizure-free period of 3-12 months, whereas seizure control has been maintained so far in all

vigabatrin in

symptomatic cases (mean follow-up 15 months). Apart from the 3 children from whom vigabatrin was withdrawn, most patients tolerated the drug well, with only mild and transient adverse events being reported in 9 (hyperkinesia, weight gain, drowsiness). These preliminary findings suggest that vigabatrin is potentially very valuable in the management of intractable IS, especially when they are associated with tuberous sclerosis, since this condition is known to have a very poor prognosis.’ INSERM U 29 and Neuropaediatric Department, Hôpital Saint Vincent de Paul, 75674 Pans Cedex, France Merrell Dow Research Institute, Winnersh Research Centre, Winnersh, Berkshire RG11 5HQ

C. CHIRON O. DULAC

phenolsulphotransferase activity could explain her sudden intolerance for red wine after marrow transplantation, and that the enzyme defect was transferred by bone-marrow transplantation. Departments of Internal Medicine, Clinical Immunology, and Transplantation Surgery, Karolinska Institute,

Huddinge Hospital, Huddinge, Sweden

S-141 86

B. LÖNNQVIST O. RINGDÉN

1. Littlewood J, Glover V, Sandler M, Petty R, Peatfield R, Rose FC. Platelet phenolsulphotransferase deficiency in dietary migraine. Lancet 1982; i: 983-86. 2. Littlewood JT, Bigg C, Glover V, Sandler M, Davies PTG, Rose FC. Red wine as a cause of migraine. Lancet 1988; i: 558-59. 3. Singleton VL, Noble AC. Wine flavour and phenolic substances. In: Charalambous G, Katz I, eds. Phenolic, sulfur and nitrogen compounds in food flavours. Am Chem Soc Symp 1976; 26: 47-70.

D. LUNA L. PALACIOS S. MONDRAGON D. BEAUMONT J. P. MUMFORD

1. Editorial. Vigabatrin. Lancet 1989; i: 532-33. 2. Luna D, Dulac O, Pajot N, Beaumont D. Vigabatrin in the treatment of childhood

3.

enzyme which inactivates a wide range of phenols. Furthermore, red wine provoked a migraine attack in most of these patients, but diluted vodka did not.2 The major chemical difference between red and white wine lies in the content of phenolic flavanoids.3 It has been reported that red wine may contain more than 20 times the amount of these complex phenols than white wine. Unfortunately, our patient relapsed and died, and the amount of the relevant enzyme in her donor-derived platelets was not investigated. However, it seems reasonable to suggest that low

activity-an

epilepsies: a single-blind placebo-controlled study. Epilepsia 1989; 30: 430-37. Jeavons PM, Bower BD. Infantile spasms: a review of the literature and a study of 112

cases. London: Heinemann Medical, 1964. 4. Jeavons PM, Bower BD, Dimitrakoudi M. Long term prognosis of 150 cases of "West syndrome". Epilepsia 1973; 14: 153-64. 5. Glaze DG, Hrachovy RA, Frost JD, Kellaway P, Zion TE. Prospective study of outcome of infants with infantile spasms treated during controlled studies of ACTH and prednisone. J Pediatr 1988; 112: 389-96. 6. Siemes H, Spohr HL, Michael TH, Nau H. Therapy of infantile spasms with valproate: results of a prospective study. Epilepsia 1988; 29: 553-60. 7. Yamamoto N, Yatanabe K, Negoro T, et al. Long-term prognosis of tuberous sclerosis with epilepsy in children. Brain Dev 1987; 9: 292-95.

Migraine precipitated by red wine after bone-marrow transplantation SIR,-Professor Williams and Dr Franklin report (Nov 25, p 1286) the case of a young man who had severe migraine after receiving a bone-marrow graft from his phenotypically HLA-matched mother, who had had migraine since childhood. We have also seen such a case. Our patient was a 44-year-old woman with a 5-year history of multiple myeloma of IgA-type. In September, 1986, she underwent bone-marrow transplantation, with her 38-year-old HLA-identical and MLC-non-reactive brother as the donor. The donor and the patient’s mother and daughter had classic migraine. The patient had grade I acute graft-versus-host disease of the skin which responded well to steroids. Two months after transplantation, during a period of cytomegalovirus reactivation with fever and pancytopenia, bacterial sinusitis developed. She had no other transplantation related complications. During the episode of sinusitis, she had her first classic migraine attack. When she recovered and was discharged she discovered that she could no longer drink more than a small glass of red wine without bringing on right-sided migraine attacks. The same amount of alcohol taken as white wine or spirits was tolerated. Infections could also precipitate migraine. Neurological examination was normal except for a mild diminution in sensation of the ring and little fingers of the right hand. Littlewood et all drew attention to the fact that patients with migraine induced by dietary factors had, compared with controls, significantly lower mean levels of platelet phenolsulphotransferase

Poliomyelitis

in the UK

SIR,-We highlight the continuing dangers of poliomyelitis infection in the British population. On Dec 14, 1988, we admitted a 65-year-old man who had been on a 1-week holiday in Morocco without taking medical advice about vaccinations or prophylactic drug treatments. While there he had a bout of diarrhoea which settled, but within 10 days of his return he had a dry cough, headache, and a raised temperature with myalgia. Paralysis of his limbs and respiratory muscles ensued. Cerebrospinal fluid showed 28 mononuclear cells and 1150 mg/1 protein, and stool culture revealed poliomyelitis virus, identified at the Public Health Laboratory Service, Colindale, as being of wild type 1. The rising serum type 1 antibody further confirmed the diagnosis of poliomyelitis infection. He needed continuous and then intermittent ventilation for 33 days, and is slowly recovering without such support. He has a profound, symmetrical lower limb weakness, and is wheelchair-bound. A review of paralytic poliomyelitis from 1970 to 19841 revealed 70 cases in England and Wales, of which 11 were contracted abroad, 17 (mainly infants) after vaccination (1 in a million chance), 12 from a vaccine contact, and 30 from an unknown source. A previous report from this unit2 emphasised the need to ensure that all nonimmunised relatives and household contacts are immunised before or at the same time as their children; this should reduce the number of contact cases.’1 Particular care should be taken to provide oral immunisation to adults travelling abroad, even if just on short sun-seeking breaks to Mediterranean countries. Immunodeficient patients should receive the inactivated and not the live vaccine (British National Formulary, September, 1989). Since only 95 % of British adults have antibodies to poliomyelitis,3 doctors should be aware of the need for continual education of patients and vigilance. Further, it is not always appreciated that wild poliomyelitis is still present in Britain, and of the nineteen wild strains obtained in Begg and colleagues’ series1 14 were contracted in England and Wales. Wessex

Neurological Centre, Southampton General Hospital, Southampton SO9 4XY, UK

C. J. ELLIS P. TELFER N. F. LAWTON

1. Begg NT, Chamberlain R, Roebuck M. Paralytic poliomyelitis in England and Wales, 1970-84. Epidemiol Infect 1987; 99: 97-106. 2. Bateman DE, Elrington G, Kennedy P, et al. Vaccine related poliomyelitis in non-immunised relatives and household contacts. Br Med J 1987; 294: 170-71. 3. Roebuck M, Chamberlain B. Prevalence of antibodies to poliovirus in 1978 among subjects aged 0-88. Br Med J 1982; 284: 697-700.

Migraine precipitated by red wine after bone-marrow transplantation.

364 16 (38%). Concomitant anti-epileptic drugs were reduced in 15, and 7 are now on vigabatrin monotherapy. Better results were seen when vigabatrin...
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