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in children using valproic acid (VPA), a subject not formerlyreported in the literature, and the effects of VPA use for a pe-riod of one year on Vitamin K reserves. Material and method:The study conducted prospectively at the Cumhuriyet Univer-sity, Turkey over a period of one year included 25 children (14male, 11 female) aged between 4 to 17 who received antiepilepticdrugs (VPA) for the first time and continued the therapy withthis single drug. Patients were divided into two stages as pre-puberty and puberty according to Tanner’s criteria, and the ratioof carboxylated osteocalcin and undercarboxylated osteocalcinwere measured using the ELISA method both pre-therapy andone year post-therapy. Findings: Although carboxylated osteocal-cin demonstrated a minimal increase in the pre-puberty group,it was observed to decrease in the puberty group. We notedthat, although higher in the pre-puberty group, undercarboxy-lated osteocalcin was observed to decrease compared with theirstart values in both groups. Discussion: The results of our studydemonstrate that the body’s Vitamin K reserves tended to de-cline in our puberty group patients, that there was a weakenedcapacity to meet the need, and that the bone metabolism wasnegatively affected.

P37 - 1895Association of Down syndrome and epilepsy with atypicalabsences and astatic seizures

Dica A, Acinte I, Tarta-Arsene O, Barca D, Iliescu C. Department ofPediatric Neurology, Clinical Hospital “Al. Obregia”, Bucharest,Romania – iliescu_catrinel@yahoo.com

Purpose: Down syndrome (DS) it is the most common geneticcondition characterized by a supplementary 21 chromosomeusually from the mother side. Association with epilepsy was de-scribed in 1.4–17% of children with DS. Most frequent types ofepilepsy in childhood are infantile spasms. Our aim is to present2 cases of girls with DS and epilepsy with generalized seizures,with astatic seizures and atypical absences respectively, withan extremely prompt response to levetiracetam. Methods andresults: Case 1: 3 years old girl with DS, with onset of epilepticspasms at 5 1/2 months old, remitted after synthetic ACTH, at 14months. Severe developmental delay with autistic traits. Onset ofastatic seizures at 1 year 9 months old, daily, frequent, interictalEEG showed generalized spikes and waves and polispikes wavesdischarges, no clinical events. Cerebral MRI showed a small rightlenticular lacunae. Extremely prompt response to levetiracetam,clinically and on EEG. Case 2: 7 years old girl with DS and moder-ate developmental delay. One febrile seizure at 1 year old. Onsetof seizures at 6 years 3 months old, with features suggestingatypical absences - staring, eyelid blinking, slight chewing, un-responsiveness, hiper/hipotonia, duration - seconds. EEG traceshowed bilateral spikes and waves discharges with associatedclinical events - as described before, 5 seconds. Levetiracetamwas started with a spectacular response - seizure control fromthe first doses. Conclusion: We wanted through this paper tohighlight the association of DS and epilepsy with generalizedseizures - astatic seizures, atypical absences - and the promptresponse of our cases to levetiracetam. Taking into considera-tion these facts, we consider that levetiracetam could be thefirst choise for children with such seizures, and maybe even forepileptic spasms associated to Down syndrome

P38 - 1894The development of a new Children’s Epilepsy Surgery Service(CESS) for England

Verity C. Cambridge, United Kingdom –christopher.verity@addenbrookes.nhs.uk

Objectives: To report on the development, the structure and

the aims of the new CESS service for England. Material andmethods: Recognising the need to improve the quality of chil-dren’s epilepsy surgery throughout England, the NHS NationalSpecialised Commissioning Team invited children’s epilepsy cen-tres to apply for a place in a new national Children’s EpilepsySurgery Service. During November 2011 an Evaluation Panel thatincluded international experts visited the centres that had ap-plied to be part of the national network. Results: The panelrecommended that there should be four centres in England andthat the care of children undergoing epilepsy surgery should beconcentrated in those centres. A National Clinical Co-ordinatingGroup has been established, made up of representatives fromeach of the four centres, to ensure that the network providesa world class service. To facilitate consistent performance anon-line database (based on International League Against Epilepsycriteria) has been developed to standardise the collection of dataabout clinical management and follow-up. Difficult cases will bediscussed between centres, working towards the development ofa “national multidisciplinary team”. Conclusions: The aim is toimprove quality by concentrating expertise and to increase thenumber of children who are assessed and treated. About 110children a year currently have epilepsy surgery in England. Itis estimated that more than double this number would benefitfrom epilepsy surgery, so there are plans to increase capacityof the service. Advances in technology have enabled detailednon-invasive assessments allowing many more children to beevaluated. The four CESS centres are eventually expected to see1,050 referrals each year with about 350 selected for surgery. Weaim to publicise the new CESS service because ongoing collabora-tion with centres around Europe will help to improve standardsof care for children undergoing this complex surgery.

P39 - 1891Compare the value of ambulatory EEG (AE) and video telemetry(VT) in diagnosis and classification of seizures

Iqbal M, Prasad M, Mordekar S, Kandler R. Sheffield ChildrensHospital, Sheffield, UK – drmehtabch@yahoo.com

Objective: Compare the value of ambulatory EEG (AE) and videotelemetry (VT) in diagnosis and classification of seizures.Method:The EEG department database was interrogated retrospectivelyfor children having both AE and VT recording during the periodMarch 1998 to August 2011. Only patients referred for purposes ofdiagnosis of attacks and classification of epilepsy were included.Patients admitted for pre-surgical evaluation of epilepsy wereexcluded. 48 patients were included in the study; M:F ratio 0.7:1,mean age 11.5 years, range 2 to 21 years. All patients had only 1telemetry but 9 patients had more than 1 ambulatory recording.For the purposes of the study the result from the ambulatoryrecording preceding the video telemetry was used. Informationregarding reason for referral and result of the long term EEGinvestigations was obtained. Results: The reason for requestwas for diagnosis of attacks in 77% of AEs and 52% of VTs,classification of epilepsy in 16% of AEs and 43% of VTs. Recordinglength for AE was: 24 hours (68%) 48 hours (25%) and 72 hours(6%). Recording length for VT was 1–3 days (60%) and 4–5 days(40%). Typical attacks were recorded in 68% of AEs and 56% ofVTs. The EEG helped in diagnosis in 66% of AEs and 62% of VTs.The EEG helped in classification in 21% of AEs and 56% of VTs.62% of patients where AE was inconclusive (21% of the total) wenton to have a VT. The combined yield of the investigations was89%. Conclusion: AE is an effective tool for diagnosing seizuresin two thirds of children. Where AE is inconclusive, VT improvesthe diagnosis in a further fifth. VT is superior to AE in classifyingseizures.