DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY. 1978, 20

The authors have replied as fol1on.s: We are grateful for Professor Illingworth’s comments. We do, in fact, use the definitions of milestones as they are conventionally and, we thought, precisely defined. That is to say by ‘sitting without support for half a minute’ we mean on a flat surface. When we discuss the naming of persons and of objects we do want the child to use a word which consistently refers to a parent or a particular object. We do not, of course, expect a one-year-old to be able to pronounce complete words. When we wrote about joining words together we were referring to two separate words combined in an individual way by the child. We did not jay in our summary that developmental history-taking is inaccurate and clinically misleading but that ‘Routine developmental history taking’ is likely to be inaccurate and misleading. A developmental history taken by an expert such as Professor Illingworth will always be clinically usetul, but a lot of past developmental history is currently recorded in child health clinics and a e doubt that this is a useful exercise. The children excluded from the sample (one child uith triple X chromosome disorder and mental retardation and 10 who were more than four weeks premature) did not form a sufficiently large group for separate analy- sis and, if included, would have made the result? for earlier milestones, particularly smiling, difficult to interpret. The sample consisted of a near-complete child population and was not a ‘highly selected group’. The study was intended to look at developmental anainnesis in mothers of presumptively normal children.

HILARY HART

Thomas Coram Research Unit, MARTIN BAX 41 Brunswick Square, SUE JENKINS London WClN IAZ.

Carbamazepine in Childhood Seizures SIR-The annotation by Sheila J . Wallace ( D M C N , 20, 223) points to the fact that car- bamazepine should probably be used more often as the drug of first choice in grand ma1 and temporal lobe seizures. I will argue that carbamazepine really is the primary anti- convulsan t for children with grand ma1 and partial seizure disorders. Carbamazepine has knocked phenytoin and the barbiturates out !

There is no difference in anticonvulsant effectiveness between these drugs, but chronic side-effects with carbamazepine are less commonly encountered. The side-effects of these tirugs have been delineated in detail by several authors, 1 3 3 9 4 * 5 - 7

Side-effects of phenytoin, which are prominent and often erroneously accepted as being natural to the person with epilepsy, are the cosmetic ones of coarse face, acne, hypertri- chosis, excessive salivation and gingival hyperplasia. Such side-effects are never desirable in childrenq2 especially during puberty when a cosmetic handicap is added to the already established handicap of the seizure disorder.

Barbiturates are sedative anticonvulsants which give rise to chronic behaviouraldiEculties6 and impair mental status. Neither does phenytoin escape this criticism.

The reason why barbiturates and phenytoin are still used as primary anticonvulsants in grand ma1 and partial seizure disorders is that these drugs have been used for such a long period. about 60 and 40 years respectively. However, this is not an adequate reason, as the interest in their side-effects has progressively increased only during the last 10 to 15 years, while carbamazepine has been very closely scrutinised during the 20 years it has been used a > an anticonvulsant.

680