Doug Brunk

SAN DIEGO — Gamma knife radiosurgery may be a viable alternative to standard open surgery for patients with mesial temporal lobe epilepsy, preliminary results from a multicenter study suggest.

“Anterior temporal lobectomy is the gold standard for the treatment of mesial temporal lobe epilepsy, so why consider an alternative therapy such as gamma knife radiosurgery?” Dr. Mark Quigg asked at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy. “Well, nothing's perfect. There's a small but significant morbidity with open surgery. Traditional surgery with its obligate ICU time and inpatient stay costs money. Many patients and some referring physicians have an unrealistic look as to what epilepsy surgery entails.”

In a 3-year multicenter study, Dr. Quigg and his associates performed gamma knife radiosurgery on 30 patients with mesial temporal lobe epilepsy. The treatment target was the temporal portion of the amygdala, the anterior 2 cm of the hippocampal gyrus, and the adjacent parahippocampal gyrus. Of the 30 patients, 17 were randomized to 20 Gy (low dose) and 13 were randomized to 24 Gy (high dose), comprising 5.0–7.5 mL at the 50% isodose volume.

The mean age of patients was 34 years and more than half (18) were female, said Dr. Quigg of the department of neurology at the University of Virginia, Charlottesville. After surgery, patients were followed for 18 months at 3-month intervals. They also were evaluated again at 24 months and 36 months.

Patients were considered seizure free if no seizures (excluding auras) occurred between the 18− and 24-month visits. At the meeting, Dr. Quigg limited his data presentation to outcomes at 24 months.

Dr. Quigg reported that overall, 67% of patients who underwent gamma knife surgery were seizure free at 24 months. A greater proportion of those who underwent high-dose gamma knife surgery were seizure free, compared with those who underwent low-dose surgery (85% vs. 56%, respectively), but the differences were not statistically significant because of the small sample size. By 24 months, one patient was lost to follow-up and another patient experienced papilledema that responded partially to dexamethasone and underwent anterior temporal lobectomy. Some patients required the supplementary use of antiepileptic drugs for auras and almost half required steroids for edema/headaches.

“The strength of the study is that the actual Gy of surgical target is very uniform amongst all of the centers,” Dr. Quigg commented.

“The rates of seizure remission are comparable to what's published for anterior lobectomy. The safety profile of these patients is within bounds of standard open surgery. It's going to take more time and perhaps a prospective comparison to sort out the relative merits of one procedure over another,” he said.

The study was supported by the National Institutes of Health and Elekta AB, maker of the Leksell Gamma Knife.

Participating sites included the University of Virginia; Columbia University, New York; Indiana University, Indianapolis; the State University of New York, Syracuse; the University of California, San Francisco; the University of Pittsburgh; the University of Southern California, Los Angeles; and the University of Washington, Seattle.

SAN DIEGO — Gamma knife radiosurgery may be a viable alternative to standard open surgery for patients with mesial temporal lobe epilepsy, preliminary results from a multicenter study suggest.

“Anterior temporal lobectomy is the gold standard for the treatment of mesial temporal lobe epilepsy, so why consider an alternative therapy such as gamma knife radiosurgery?” Dr. Mark Quigg asked at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy. “Well, nothing's perfect. There's a small but significant morbidity with open surgery. Traditional surgery with its obligate ICU time and inpatient stay costs money. Many patients and some referring physicians have an unrealistic look as to what epilepsy surgery entails.”

In a 3-year multicenter study, Dr. Quigg and his associates performed gamma knife radiosurgery on 30 patients with mesial temporal lobe epilepsy. The treatment target was the temporal portion of the amygdala, the anterior 2 cm of the hippocampal gyrus, and the adjacent parahippocampal gyrus. Of the 30 patients, 17 were randomized to 20 Gy (low dose) and 13 were randomized to 24 Gy (high dose), comprising 5.0–7.5 mL at the 50% isodose volume.

The mean age of patients was 34 years and more than half (18) were female, said Dr. Quigg of the department of neurology at the University of Virginia, Charlottesville. After surgery, patients were followed for 18 months at 3-month intervals. They also were evaluated again at 24 months and 36 months.

Patients were considered seizure free if no seizures (excluding auras) occurred between the 18− and 24-month visits. At the meeting, Dr. Quigg limited his data presentation to outcomes at 24 months.

Dr. Quigg reported that overall, 67% of patients who underwent gamma knife surgery were seizure free at 24 months. A greater proportion of those who underwent high-dose gamma knife surgery were seizure free, compared with those who underwent low-dose surgery (85% vs. 56%, respectively), but the differences were not statistically significant because of the small sample size. By 24 months, one patient was lost to follow-up and another patient experienced papilledema that responded partially to dexamethasone and underwent anterior temporal lobectomy. Some patients required the supplementary use of antiepileptic drugs for auras and almost half required steroids for edema/headaches.

“The strength of the study is that the actual Gy of surgical target is very uniform amongst all of the centers,” Dr. Quigg commented.

“The rates of seizure remission are comparable to what's published for anterior lobectomy. The safety profile of these patients is within bounds of standard open surgery. It's going to take more time and perhaps a prospective comparison to sort out the relative merits of one procedure over another,” he said.

The study was supported by the National Institutes of Health and Elekta AB, maker of the Leksell Gamma Knife.

Participating sites included the University of Virginia; Columbia University, New York; Indiana University, Indianapolis; the State University of New York, Syracuse; the University of California, San Francisco; the University of Pittsburgh; the University of Southern California, Los Angeles; and the University of Washington, Seattle.

SAN DIEGO — Gamma knife radiosurgery may be a viable alternative to standard open surgery for patients with mesial temporal lobe epilepsy, preliminary results from a multicenter study suggest.

“Anterior temporal lobectomy is the gold standard for the treatment of mesial temporal lobe epilepsy, so why consider an alternative therapy such as gamma knife radiosurgery?” Dr. Mark Quigg asked at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy. “Well, nothing's perfect. There's a small but significant morbidity with open surgery. Traditional surgery with its obligate ICU time and inpatient stay costs money. Many patients and some referring physicians have an unrealistic look as to what epilepsy surgery entails.”

In a 3-year multicenter study, Dr. Quigg and his associates performed gamma knife radiosurgery on 30 patients with mesial temporal lobe epilepsy. The treatment target was the temporal portion of the amygdala, the anterior 2 cm of the hippocampal gyrus, and the adjacent parahippocampal gyrus. Of the 30 patients, 17 were randomized to 20 Gy (low dose) and 13 were randomized to 24 Gy (high dose), comprising 5.0–7.5 mL at the 50% isodose volume.

The mean age of patients was 34 years and more than half (18) were female, said Dr. Quigg of the department of neurology at the University of Virginia, Charlottesville. After surgery, patients were followed for 18 months at 3-month intervals. They also were evaluated again at 24 months and 36 months.

Patients were considered seizure free if no seizures (excluding auras) occurred between the 18− and 24-month visits. At the meeting, Dr. Quigg limited his data presentation to outcomes at 24 months.

Dr. Quigg reported that overall, 67% of patients who underwent gamma knife surgery were seizure free at 24 months. A greater proportion of those who underwent high-dose gamma knife surgery were seizure free, compared with those who underwent low-dose surgery (85% vs. 56%, respectively), but the differences were not statistically significant because of the small sample size. By 24 months, one patient was lost to follow-up and another patient experienced papilledema that responded partially to dexamethasone and underwent anterior temporal lobectomy. Some patients required the supplementary use of antiepileptic drugs for auras and almost half required steroids for edema/headaches.

“The strength of the study is that the actual Gy of surgical target is very uniform amongst all of the centers,” Dr. Quigg commented.

“The rates of seizure remission are comparable to what's published for anterior lobectomy. The safety profile of these patients is within bounds of standard open surgery. It's going to take more time and perhaps a prospective comparison to sort out the relative merits of one procedure over another,” he said.

The study was supported by the National Institutes of Health and Elekta AB, maker of the Leksell Gamma Knife.

Participating sites included the University of Virginia; Columbia University, New York; Indiana University, Indianapolis; the State University of New York, Syracuse; the University of California, San Francisco; the University of Pittsburgh; the University of Southern California, Los Angeles; and the University of Washington, Seattle.

LAS VEGAS — If a limping child presents to your office and imaging is being considered, make sure to consult a radiologist who has experience imaging the pediatric hip and spine, Dr. Melvin O. Senac Jr. advised at a meeting sponsored by the American Academy of Pediatrics' California Chapters 1, 2, 3, and 4 and the AAP.

“Have a radiologist you can trust,” said Dr. Senac, medical director and chief of radiology at Children's Hospital San Diego. “The imaging modalities are changing so fast, whether it's the new 64- channel CT scanners or new sequences in MRI, it's hard to really keep up. If you have a problem with one of your kids and you just don't know how to approach it from an imaging standpoint, pick up the phone and call or go by and talk to your radiologist. We're really trying to do the fewest [number of imaging] tests possible.”

He discussed these causes of limping in children:

▸ Diskitis. This condition is marked by back pain, limping, failure to bear weight, and low-grade fever. It can affect infants less than 1 year old as well as teenagers.

In toddlers, nerve root irritation often causes hip pain that is worse than back pain, said Dr. Senac, who is also a professor of radiology at the University of California, San Diego. The white blood cell count is usually normal but the erythrocyte sedimentation rate is usually elevated.

Bacterial infection, usually Staphylococcus aureus, is the most common etiology of diskitis. The primary nidus is the vertebral end plate. Long-term sequelae include normal to severe kyphosis.

“One of the hallmarks of plain film findings in diskitis is narrowing of the disk space with end-plate irregularity,” Dr. Senac said.

“It's usually going to be at L 3–4 or L 4–5. We see it throughout childhood, [but] it takes about 2 weeks for us to start seeing plain film findings of these irregularities. The earliest manifestation we see of diskitis is on MRI.”

▸ Developmental dysplasia of the hip (DDH). The four radiographic hallmarks of this condition include a small or nonossified femoral head on the affected side, increased acetabular angle, a laterally displaced femoral head, and interruption of Shenton's line.

“The earlier you pick it up, the better that child is going to do,” he said.

If the DDH diagnosis is made at under 6 months of age, treatment involves use of a Pavlik restraint harness to position the hip in flexion and abduction. These children “do well and they'll go on to have a normal hip,” he said.

If the diagnosis is made between ages 6 and 24 months, “those kids generally have to be hospitalized, put in traction, then taken to OR,” he said. “Then, under general anesthesia, there's an attempt at reduction. Then they're put in a cast for 6–9 months.”

If the diagnosis is made after the age of 24 months, treatment involves an open reduction. “Those kids will always have gait problems down the line,” Dr. Senac said.

But even if a diagnosis is made early, several months of treatment is required. “If you pick it up in the first 6 weeks, then the average stay in a harness is about 3.5 months,” he said. “If you don't make the call until 6 weeks to 3 months of age, the average stay in the harness is about 7 months. It goes up to 9 months if you diagnose it between 3 and 6 months.”

To confirm DDH, Dr. Senac recommends ultrasound in children younger than 4 months of age and radiographs in children aged 4 months and older. He pointed out that there is a steep learning curve to performing hip ultrasound on young infants, “so if you don't have a pediatric radiologist who does this, I suggest that the family drive somewhere to a facility that's doing a lot of these.”

▸ Transient synovitis. This is the most common nontraumatic cause of acute limp in children aged 5–10 years. The etiology is unknown but is thought to be a nonspecific anti-inflammatory response of synovium to an antecedent viral or bacterial infection.

Clinical exam may reveal limp, or hip or knee pain. Affected children have low-grade fever in about 25% of cases and a mildly elevated erythrocyte sedimentation rate in 50% of cases.

“It is a diagnosis of exclusion,” Dr. Senac said. “If we do sophisticated MRI or [ultrasound], we'll find a little fluid in the joint. That's all we see.”

Radiographs are usually normal but may show a small hip effusion. Scintigraphy is more sensitive but nonspecific.

Children can expect complete recovery within a few weeks.

▸ Septic arthritis. He called this condition “the scariest thing that we have to face in this age group [aged 1–4 years] in regard to the limping child.” Affected kids experience severe pain in the involved joint, most often the hip. They usually have a fever and an elevated white blood count. On radiographs, “we're looking for widening of the joint space to see if there's evidence of a hip effusion,” Dr. Senac said.

The condition is hematogenous, “so you commonly have underlying osteomyelitis coupled with the septic joint,” he noted

If conventional radiographs are nondiagnostic and the physical exam is equivocal, then an MRI or a radionuclide bone scan should be obtained on an urgent basis. “Time is of the essence, as the proteolytic enzymes from the hip infection can rapidly destroy cartilage and subsequently the hip joint,” he noted.

Treatment consists of draining the hip surgically and placing the child on intravenous antibiotics.

If there is adjacent osteomyelitis, then this bone needs to be drained, generally by drilling.

LAS VEGAS — If a limping child presents to your office and imaging is being considered, make sure to consult a radiologist who has experience imaging the pediatric hip and spine, Dr. Melvin O. Senac Jr. advised at a meeting sponsored by the American Academy of Pediatrics' California Chapters 1, 2, 3, and 4 and the AAP.

“Have a radiologist you can trust,” said Dr. Senac, medical director and chief of radiology at Children's Hospital San Diego. “The imaging modalities are changing so fast, whether it's the new 64- channel CT scanners or new sequences in MRI, it's hard to really keep up. If you have a problem with one of your kids and you just don't know how to approach it from an imaging standpoint, pick up the phone and call or go by and talk to your radiologist. We're really trying to do the fewest [number of imaging] tests possible.”

He discussed these causes of limping in children:

▸ Diskitis. This condition is marked by back pain, limping, failure to bear weight, and low-grade fever. It can affect infants less than 1 year old as well as teenagers.

In toddlers, nerve root irritation often causes hip pain that is worse than back pain, said Dr. Senac, who is also a professor of radiology at the University of California, San Diego. The white blood cell count is usually normal but the erythrocyte sedimentation rate is usually elevated.

Bacterial infection, usually Staphylococcus aureus, is the most common etiology of diskitis. The primary nidus is the vertebral end plate. Long-term sequelae include normal to severe kyphosis.

“One of the hallmarks of plain film findings in diskitis is narrowing of the disk space with end-plate irregularity,” Dr. Senac said.

“It's usually going to be at L 3–4 or L 4–5. We see it throughout childhood, [but] it takes about 2 weeks for us to start seeing plain film findings of these irregularities. The earliest manifestation we see of diskitis is on MRI.”

▸ Developmental dysplasia of the hip (DDH). The four radiographic hallmarks of this condition include a small or nonossified femoral head on the affected side, increased acetabular angle, a laterally displaced femoral head, and interruption of Shenton's line.

“The earlier you pick it up, the better that child is going to do,” he said.

If the DDH diagnosis is made at under 6 months of age, treatment involves use of a Pavlik restraint harness to position the hip in flexion and abduction. These children “do well and they'll go on to have a normal hip,” he said.

If the diagnosis is made between ages 6 and 24 months, “those kids generally have to be hospitalized, put in traction, then taken to OR,” he said. “Then, under general anesthesia, there's an attempt at reduction. Then they're put in a cast for 6–9 months.”

If the diagnosis is made after the age of 24 months, treatment involves an open reduction. “Those kids will always have gait problems down the line,” Dr. Senac said.

But even if a diagnosis is made early, several months of treatment is required. “If you pick it up in the first 6 weeks, then the average stay in a harness is about 3.5 months,” he said. “If you don't make the call until 6 weeks to 3 months of age, the average stay in the harness is about 7 months. It goes up to 9 months if you diagnose it between 3 and 6 months.”

To confirm DDH, Dr. Senac recommends ultrasound in children younger than 4 months of age and radiographs in children aged 4 months and older. He pointed out that there is a steep learning curve to performing hip ultrasound on young infants, “so if you don't have a pediatric radiologist who does this, I suggest that the family drive somewhere to a facility that's doing a lot of these.”

▸ Transient synovitis. This is the most common nontraumatic cause of acute limp in children aged 5–10 years. The etiology is unknown but is thought to be a nonspecific anti-inflammatory response of synovium to an antecedent viral or bacterial infection.

Clinical exam may reveal limp, or hip or knee pain. Affected children have low-grade fever in about 25% of cases and a mildly elevated erythrocyte sedimentation rate in 50% of cases.

“It is a diagnosis of exclusion,” Dr. Senac said. “If we do sophisticated MRI or [ultrasound], we'll find a little fluid in the joint. That's all we see.”

Radiographs are usually normal but may show a small hip effusion. Scintigraphy is more sensitive but nonspecific.

Children can expect complete recovery within a few weeks.

▸ Septic arthritis. He called this condition “the scariest thing that we have to face in this age group [aged 1–4 years] in regard to the limping child.” Affected kids experience severe pain in the involved joint, most often the hip. They usually have a fever and an elevated white blood count. On radiographs, “we're looking for widening of the joint space to see if there's evidence of a hip effusion,” Dr. Senac said.

The condition is hematogenous, “so you commonly have underlying osteomyelitis coupled with the septic joint,” he noted

If conventional radiographs are nondiagnostic and the physical exam is equivocal, then an MRI or a radionuclide bone scan should be obtained on an urgent basis. “Time is of the essence, as the proteolytic enzymes from the hip infection can rapidly destroy cartilage and subsequently the hip joint,” he noted.

Treatment consists of draining the hip surgically and placing the child on intravenous antibiotics.

If there is adjacent osteomyelitis, then this bone needs to be drained, generally by drilling.

LAS VEGAS — If a limping child presents to your office and imaging is being considered, make sure to consult a radiologist who has experience imaging the pediatric hip and spine, Dr. Melvin O. Senac Jr. advised at a meeting sponsored by the American Academy of Pediatrics' California Chapters 1, 2, 3, and 4 and the AAP.

“Have a radiologist you can trust,” said Dr. Senac, medical director and chief of radiology at Children's Hospital San Diego. “The imaging modalities are changing so fast, whether it's the new 64- channel CT scanners or new sequences in MRI, it's hard to really keep up. If you have a problem with one of your kids and you just don't know how to approach it from an imaging standpoint, pick up the phone and call or go by and talk to your radiologist. We're really trying to do the fewest [number of imaging] tests possible.”

He discussed these causes of limping in children:

▸ Diskitis. This condition is marked by back pain, limping, failure to bear weight, and low-grade fever. It can affect infants less than 1 year old as well as teenagers.

In toddlers, nerve root irritation often causes hip pain that is worse than back pain, said Dr. Senac, who is also a professor of radiology at the University of California, San Diego. The white blood cell count is usually normal but the erythrocyte sedimentation rate is usually elevated.

Bacterial infection, usually Staphylococcus aureus, is the most common etiology of diskitis. The primary nidus is the vertebral end plate. Long-term sequelae include normal to severe kyphosis.

“One of the hallmarks of plain film findings in diskitis is narrowing of the disk space with end-plate irregularity,” Dr. Senac said.

“It's usually going to be at L 3–4 or L 4–5. We see it throughout childhood, [but] it takes about 2 weeks for us to start seeing plain film findings of these irregularities. The earliest manifestation we see of diskitis is on MRI.”

▸ Developmental dysplasia of the hip (DDH). The four radiographic hallmarks of this condition include a small or nonossified femoral head on the affected side, increased acetabular angle, a laterally displaced femoral head, and interruption of Shenton's line.

“The earlier you pick it up, the better that child is going to do,” he said.

If the DDH diagnosis is made at under 6 months of age, treatment involves use of a Pavlik restraint harness to position the hip in flexion and abduction. These children “do well and they'll go on to have a normal hip,” he said.

If the diagnosis is made between ages 6 and 24 months, “those kids generally have to be hospitalized, put in traction, then taken to OR,” he said. “Then, under general anesthesia, there's an attempt at reduction. Then they're put in a cast for 6–9 months.”

If the diagnosis is made after the age of 24 months, treatment involves an open reduction. “Those kids will always have gait problems down the line,” Dr. Senac said.

But even if a diagnosis is made early, several months of treatment is required. “If you pick it up in the first 6 weeks, then the average stay in a harness is about 3.5 months,” he said. “If you don't make the call until 6 weeks to 3 months of age, the average stay in the harness is about 7 months. It goes up to 9 months if you diagnose it between 3 and 6 months.”

To confirm DDH, Dr. Senac recommends ultrasound in children younger than 4 months of age and radiographs in children aged 4 months and older. He pointed out that there is a steep learning curve to performing hip ultrasound on young infants, “so if you don't have a pediatric radiologist who does this, I suggest that the family drive somewhere to a facility that's doing a lot of these.”

▸ Transient synovitis. This is the most common nontraumatic cause of acute limp in children aged 5–10 years. The etiology is unknown but is thought to be a nonspecific anti-inflammatory response of synovium to an antecedent viral or bacterial infection.

Clinical exam may reveal limp, or hip or knee pain. Affected children have low-grade fever in about 25% of cases and a mildly elevated erythrocyte sedimentation rate in 50% of cases.

“It is a diagnosis of exclusion,” Dr. Senac said. “If we do sophisticated MRI or [ultrasound], we'll find a little fluid in the joint. That's all we see.”

Radiographs are usually normal but may show a small hip effusion. Scintigraphy is more sensitive but nonspecific.

Children can expect complete recovery within a few weeks.

▸ Septic arthritis. He called this condition “the scariest thing that we have to face in this age group [aged 1–4 years] in regard to the limping child.” Affected kids experience severe pain in the involved joint, most often the hip. They usually have a fever and an elevated white blood count. On radiographs, “we're looking for widening of the joint space to see if there's evidence of a hip effusion,” Dr. Senac said.

The condition is hematogenous, “so you commonly have underlying osteomyelitis coupled with the septic joint,” he noted

If conventional radiographs are nondiagnostic and the physical exam is equivocal, then an MRI or a radionuclide bone scan should be obtained on an urgent basis. “Time is of the essence, as the proteolytic enzymes from the hip infection can rapidly destroy cartilage and subsequently the hip joint,” he noted.

Treatment consists of draining the hip surgically and placing the child on intravenous antibiotics.

If there is adjacent osteomyelitis, then this bone needs to be drained, generally by drilling.

SAN DIEGO — In utero exposure to valproate is associated with a greater risk of cognitive impairment in offspring, compared with exposure to other commonly used antiepileptic medications, Dr. Kimford J. Meador reported at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy.

“Further studies are needed to investigate additional [antiepileptic] drugs that have not been studied and determine if the effects we see here continue,” said Dr. Meador, a neurologist who directs the epilepsy program in the department of neurology at the University of Florida, Gainesville.

The findings come from a preliminary analysis of cognitive data from the ongoing Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study, a 25-center trial in the United States and England that is funded by the National Institute of Neurological Disorders and Stroke. The long-term goal of NEAD is to examine children born to mothers with epilepsy at 6 years of age to see if differential neuropsychological effects are associated with in utero exposure to the four most commonly prescribed antiepileptic medications.

Dr. Meador and his associates performed neuropsychological testing on 2-year-old children born to mothers with partial or primary generalized epilepsy who were on antiepileptic monotherapy with carbamazepine, lamotrigine, phenytoin, or valproate. Subsequent testing was performed when the children were aged 3.5, 4, and 6 years.

The researchers administered the mental scale of the Bayley Scales of Infant Development and analyzed the children's Mental Developmental Index (MDI) scores while controlling for maternal IQ.

At the meeting, Dr. Meador presented 2-year data on 185 children in the study. During pregnancy, 48 of the children were exposed to carbamazepine, 66 to lamotrigine, 42 to phenytoin, and 29 to valproate.

The mean MDI scores were 93 in children exposed to carbamazepine, 97 in those exposed to lamotrigine, 91 in those exposed to phenytoin, and 86 in those exposed to valproate. An MDI score of 100 represents the mean score in a normal population.

Almost one-quarter of children exposed to valproate (24%) had MDIs of less than 70, compared with 12% of those exposed to carbamazepine, 11% of those exposed to lamotrigine, and 12% of those exposed to phenytoin.

The apparent adverse effect of valproate was related to anticonvulsant blood level. “This is true whether we analyzed it for blood levels across the entire pregnancy or for just the third trimester,” Dr. Meador noted. The pattern also held true after the researchers controlled for confounding factors, including seizure frequency, maternal age, history of alcohol use during pregnancy, and gestational age.

SAN DIEGO — In utero exposure to valproate is associated with a greater risk of cognitive impairment in offspring, compared with exposure to other commonly used antiepileptic medications, Dr. Kimford J. Meador reported at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy.

“Further studies are needed to investigate additional [antiepileptic] drugs that have not been studied and determine if the effects we see here continue,” said Dr. Meador, a neurologist who directs the epilepsy program in the department of neurology at the University of Florida, Gainesville.

The findings come from a preliminary analysis of cognitive data from the ongoing Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study, a 25-center trial in the United States and England that is funded by the National Institute of Neurological Disorders and Stroke. The long-term goal of NEAD is to examine children born to mothers with epilepsy at 6 years of age to see if differential neuropsychological effects are associated with in utero exposure to the four most commonly prescribed antiepileptic medications.

Dr. Meador and his associates performed neuropsychological testing on 2-year-old children born to mothers with partial or primary generalized epilepsy who were on antiepileptic monotherapy with carbamazepine, lamotrigine, phenytoin, or valproate. Subsequent testing was performed when the children were aged 3.5, 4, and 6 years.

The researchers administered the mental scale of the Bayley Scales of Infant Development and analyzed the children's Mental Developmental Index (MDI) scores while controlling for maternal IQ.

At the meeting, Dr. Meador presented 2-year data on 185 children in the study. During pregnancy, 48 of the children were exposed to carbamazepine, 66 to lamotrigine, 42 to phenytoin, and 29 to valproate.

The mean MDI scores were 93 in children exposed to carbamazepine, 97 in those exposed to lamotrigine, 91 in those exposed to phenytoin, and 86 in those exposed to valproate. An MDI score of 100 represents the mean score in a normal population.

Almost one-quarter of children exposed to valproate (24%) had MDIs of less than 70, compared with 12% of those exposed to carbamazepine, 11% of those exposed to lamotrigine, and 12% of those exposed to phenytoin.

The apparent adverse effect of valproate was related to anticonvulsant blood level. “This is true whether we analyzed it for blood levels across the entire pregnancy or for just the third trimester,” Dr. Meador noted. The pattern also held true after the researchers controlled for confounding factors, including seizure frequency, maternal age, history of alcohol use during pregnancy, and gestational age.

SAN DIEGO — In utero exposure to valproate is associated with a greater risk of cognitive impairment in offspring, compared with exposure to other commonly used antiepileptic medications, Dr. Kimford J. Meador reported at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy.

“Further studies are needed to investigate additional [antiepileptic] drugs that have not been studied and determine if the effects we see here continue,” said Dr. Meador, a neurologist who directs the epilepsy program in the department of neurology at the University of Florida, Gainesville.

The findings come from a preliminary analysis of cognitive data from the ongoing Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study, a 25-center trial in the United States and England that is funded by the National Institute of Neurological Disorders and Stroke. The long-term goal of NEAD is to examine children born to mothers with epilepsy at 6 years of age to see if differential neuropsychological effects are associated with in utero exposure to the four most commonly prescribed antiepileptic medications.

Dr. Meador and his associates performed neuropsychological testing on 2-year-old children born to mothers with partial or primary generalized epilepsy who were on antiepileptic monotherapy with carbamazepine, lamotrigine, phenytoin, or valproate. Subsequent testing was performed when the children were aged 3.5, 4, and 6 years.

The researchers administered the mental scale of the Bayley Scales of Infant Development and analyzed the children's Mental Developmental Index (MDI) scores while controlling for maternal IQ.

At the meeting, Dr. Meador presented 2-year data on 185 children in the study. During pregnancy, 48 of the children were exposed to carbamazepine, 66 to lamotrigine, 42 to phenytoin, and 29 to valproate.

The mean MDI scores were 93 in children exposed to carbamazepine, 97 in those exposed to lamotrigine, 91 in those exposed to phenytoin, and 86 in those exposed to valproate. An MDI score of 100 represents the mean score in a normal population.

Almost one-quarter of children exposed to valproate (24%) had MDIs of less than 70, compared with 12% of those exposed to carbamazepine, 11% of those exposed to lamotrigine, and 12% of those exposed to phenytoin.

The apparent adverse effect of valproate was related to anticonvulsant blood level. “This is true whether we analyzed it for blood levels across the entire pregnancy or for just the third trimester,” Dr. Meador noted. The pattern also held true after the researchers controlled for confounding factors, including seizure frequency, maternal age, history of alcohol use during pregnancy, and gestational age.

SAN DIEGO — A survey of women with epilepsy showed that only about half used a highly effective method of birth control, Dr. Alison M. Pack reported in a poster session at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy.

The findings underscore the importance of asking women with epilepsy about their birth control methods, said Dr. Pack of the department of neurology at Columbia University, New York.

“It's not something you ask about once. I think you need to include it in each of your visits with patients,” she said in an interview. “You have to ask them what their method of contraception is, and I think you need to counsel them on that.”

In what she said is the largest study of its kind, Dr. Pack and her associates asked 180 female patients with epilepsy aged 18–44 years to complete a questionnaire between July 2005 and February 2006 about their reproductive history, sexual behavior, current risk of pregnancy, and contraceptive use. The women were patients at Columbia's epilepsy center and at two other New York-based clinics specializing in treating patients with the disorder.

Of the 180 women, 148 (82%) completed the questionnaire. Their mean age was 32 years; 32% described themselves as Hispanic. The women reported a wide range of educational attainment and income levels. Most (93%) described themselves as heterosexual, three as homosexual, three as bisexual, and four did not answer.

Of the 78 respondents who reported having sexual intercourse in the past 30 days, 58 (74%) used contraception.

Contraceptive methods included male condoms (36%), withdrawal (31%), oral contraception (27%), male or female sterilization (17%), contraceptive patch (5%), rhythm method (5%), intrauterine device (2%), depot medroxyprogesterone (Depo-Provera) (2%), and “other” (19%).

The researchers also found that of the 21 women who reported using a hormonal birth control method, 6 (29%) took an enzyme-inducing antiepileptic drug that is known to increase susceptibility to pregnancy. The respondents reported 181 pregnancies, of which 91 (50%) were unplanned.

SAN DIEGO — A survey of women with epilepsy showed that only about half used a highly effective method of birth control, Dr. Alison M. Pack reported in a poster session at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy.

The findings underscore the importance of asking women with epilepsy about their birth control methods, said Dr. Pack of the department of neurology at Columbia University, New York.

“It's not something you ask about once. I think you need to include it in each of your visits with patients,” she said in an interview. “You have to ask them what their method of contraception is, and I think you need to counsel them on that.”

In what she said is the largest study of its kind, Dr. Pack and her associates asked 180 female patients with epilepsy aged 18–44 years to complete a questionnaire between July 2005 and February 2006 about their reproductive history, sexual behavior, current risk of pregnancy, and contraceptive use. The women were patients at Columbia's epilepsy center and at two other New York-based clinics specializing in treating patients with the disorder.

Of the 180 women, 148 (82%) completed the questionnaire. Their mean age was 32 years; 32% described themselves as Hispanic. The women reported a wide range of educational attainment and income levels. Most (93%) described themselves as heterosexual, three as homosexual, three as bisexual, and four did not answer.

Of the 78 respondents who reported having sexual intercourse in the past 30 days, 58 (74%) used contraception.

Contraceptive methods included male condoms (36%), withdrawal (31%), oral contraception (27%), male or female sterilization (17%), contraceptive patch (5%), rhythm method (5%), intrauterine device (2%), depot medroxyprogesterone (Depo-Provera) (2%), and “other” (19%).

The researchers also found that of the 21 women who reported using a hormonal birth control method, 6 (29%) took an enzyme-inducing antiepileptic drug that is known to increase susceptibility to pregnancy. The respondents reported 181 pregnancies, of which 91 (50%) were unplanned.

SAN DIEGO — A survey of women with epilepsy showed that only about half used a highly effective method of birth control, Dr. Alison M. Pack reported in a poster session at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy.

The findings underscore the importance of asking women with epilepsy about their birth control methods, said Dr. Pack of the department of neurology at Columbia University, New York.

“It's not something you ask about once. I think you need to include it in each of your visits with patients,” she said in an interview. “You have to ask them what their method of contraception is, and I think you need to counsel them on that.”

In what she said is the largest study of its kind, Dr. Pack and her associates asked 180 female patients with epilepsy aged 18–44 years to complete a questionnaire between July 2005 and February 2006 about their reproductive history, sexual behavior, current risk of pregnancy, and contraceptive use. The women were patients at Columbia's epilepsy center and at two other New York-based clinics specializing in treating patients with the disorder.

Of the 180 women, 148 (82%) completed the questionnaire. Their mean age was 32 years; 32% described themselves as Hispanic. The women reported a wide range of educational attainment and income levels. Most (93%) described themselves as heterosexual, three as homosexual, three as bisexual, and four did not answer.

Of the 78 respondents who reported having sexual intercourse in the past 30 days, 58 (74%) used contraception.

Contraceptive methods included male condoms (36%), withdrawal (31%), oral contraception (27%), male or female sterilization (17%), contraceptive patch (5%), rhythm method (5%), intrauterine device (2%), depot medroxyprogesterone (Depo-Provera) (2%), and “other” (19%).

The researchers also found that of the 21 women who reported using a hormonal birth control method, 6 (29%) took an enzyme-inducing antiepileptic drug that is known to increase susceptibility to pregnancy. The respondents reported 181 pregnancies, of which 91 (50%) were unplanned.

SAN DIEGO – Preschool children with attention-deficit hyperactivity disorder who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with children who had fewer comorbid disorders, according to the results of a randomized study.

Dr. Jaswinder K. Ghuman reported the findings of a secondary analysis of the National Institute of Mental Health Preschool and Treatment Study (PATS) at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Dr. Ghuman and her associates examined baseline characteristics of methylphenidate treatment response in 165 children aged 3.5–5 years who were randomized to methylphenidate over a 5-week period. The doses ranged from 7.5 mg/day to 22 mg/day.

Of the 165 children, 47 (28%) had no comorbid disorder, 69 (42%) had two comorbid disorders, and 15 (9%) had three to four comorbid disorders, reported Dr. Ghuman, who directs the infant and preschool program in the division of child and adolescent psychiatry at the University of Arizona in Tucson.

Oppositional defiant disorder was the most common comorbid disorder, followed by communication disorders and anxiety disorder.

She and her associates found that study participants who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with those who had two, one, or no comorbid disorders.

They also found no evidence that age, ethnicity, gender, intelligence quotient, ADHD subtype and severity, or the mother's education level influenced treatment outcome.

In a separate presentation at the meeting, Howard Abikoff, Ph.D., discussed a subset analysis of 114 children in the PATS who improved with methylphenidate treatment. Of the 114 children, 61 received methylphenidate and 53 received placebo over a period of 4 weeks.

He and his associates compared the two groups of children to see whether the methylphenidate improved children's social skills, classroom behavior, and ratings of parenting stress.

At baseline and at week 4, the investigators administered the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) scale, the Social Competence Scale (SCS), the Parenting Stress Index (PSI), and the Clinical Global Impression-Severity (CGI-S) scale.

Of the 114 children, 24 in the placebo group and 9 in the treatment group dropped out because their behavior deteriorated, said Dr. Abikoff, who directs the Institute for Attention Deficit and Hyperactivity and Behavior Disorders at New York University, New York. Two others declined study participation and one had medication-related side effects, resulting in a total of 36 children who dropped out of the study.

Dr. Abikoff reported that the placebo and treatment groups did not differ significantly in the parents' ratings for the SWAN, SCS, and PSI, or in the SWAN teacher ratings. However, the children's teachers rated children in the treatment group as significantly improved on the SCS, compared with their peers in the placebo group.

“The teachers were picking up something,” Dr. Abikoff said at the meeting. “Is that because teachers had an opportunity to judge a child's social functioning, compared to hundreds of other children they've worked with, and also because they're seeing that child interact with many children day in and day out, whereas parents are limited in what they're able to see?”

He also noted that results of the clinician CGI-S ratings showed significantly more improvement among children in the treatment group, compared with those in the placebo group.

Dr. Abikoff said the findings underscore “the need for multiple informants when you're working with children with ADHD, regardless of their age, but certainly when they're in the preschool range.

SAN DIEGO – Preschool children with attention-deficit hyperactivity disorder who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with children who had fewer comorbid disorders, according to the results of a randomized study.

Dr. Jaswinder K. Ghuman reported the findings of a secondary analysis of the National Institute of Mental Health Preschool and Treatment Study (PATS) at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Dr. Ghuman and her associates examined baseline characteristics of methylphenidate treatment response in 165 children aged 3.5–5 years who were randomized to methylphenidate over a 5-week period. The doses ranged from 7.5 mg/day to 22 mg/day.

Of the 165 children, 47 (28%) had no comorbid disorder, 69 (42%) had two comorbid disorders, and 15 (9%) had three to four comorbid disorders, reported Dr. Ghuman, who directs the infant and preschool program in the division of child and adolescent psychiatry at the University of Arizona in Tucson.

Oppositional defiant disorder was the most common comorbid disorder, followed by communication disorders and anxiety disorder.

She and her associates found that study participants who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with those who had two, one, or no comorbid disorders.

They also found no evidence that age, ethnicity, gender, intelligence quotient, ADHD subtype and severity, or the mother's education level influenced treatment outcome.

In a separate presentation at the meeting, Howard Abikoff, Ph.D., discussed a subset analysis of 114 children in the PATS who improved with methylphenidate treatment. Of the 114 children, 61 received methylphenidate and 53 received placebo over a period of 4 weeks.

He and his associates compared the two groups of children to see whether the methylphenidate improved children's social skills, classroom behavior, and ratings of parenting stress.

At baseline and at week 4, the investigators administered the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) scale, the Social Competence Scale (SCS), the Parenting Stress Index (PSI), and the Clinical Global Impression-Severity (CGI-S) scale.

Of the 114 children, 24 in the placebo group and 9 in the treatment group dropped out because their behavior deteriorated, said Dr. Abikoff, who directs the Institute for Attention Deficit and Hyperactivity and Behavior Disorders at New York University, New York. Two others declined study participation and one had medication-related side effects, resulting in a total of 36 children who dropped out of the study.

Dr. Abikoff reported that the placebo and treatment groups did not differ significantly in the parents' ratings for the SWAN, SCS, and PSI, or in the SWAN teacher ratings. However, the children's teachers rated children in the treatment group as significantly improved on the SCS, compared with their peers in the placebo group.

“The teachers were picking up something,” Dr. Abikoff said at the meeting. “Is that because teachers had an opportunity to judge a child's social functioning, compared to hundreds of other children they've worked with, and also because they're seeing that child interact with many children day in and day out, whereas parents are limited in what they're able to see?”

He also noted that results of the clinician CGI-S ratings showed significantly more improvement among children in the treatment group, compared with those in the placebo group.

Dr. Abikoff said the findings underscore “the need for multiple informants when you're working with children with ADHD, regardless of their age, but certainly when they're in the preschool range.

SAN DIEGO – Preschool children with attention-deficit hyperactivity disorder who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with children who had fewer comorbid disorders, according to the results of a randomized study.

Dr. Jaswinder K. Ghuman reported the findings of a secondary analysis of the National Institute of Mental Health Preschool and Treatment Study (PATS) at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Dr. Ghuman and her associates examined baseline characteristics of methylphenidate treatment response in 165 children aged 3.5–5 years who were randomized to methylphenidate over a 5-week period. The doses ranged from 7.5 mg/day to 22 mg/day.

Of the 165 children, 47 (28%) had no comorbid disorder, 69 (42%) had two comorbid disorders, and 15 (9%) had three to four comorbid disorders, reported Dr. Ghuman, who directs the infant and preschool program in the division of child and adolescent psychiatry at the University of Arizona in Tucson.

Oppositional defiant disorder was the most common comorbid disorder, followed by communication disorders and anxiety disorder.

She and her associates found that study participants who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with those who had two, one, or no comorbid disorders.

They also found no evidence that age, ethnicity, gender, intelligence quotient, ADHD subtype and severity, or the mother's education level influenced treatment outcome.

In a separate presentation at the meeting, Howard Abikoff, Ph.D., discussed a subset analysis of 114 children in the PATS who improved with methylphenidate treatment. Of the 114 children, 61 received methylphenidate and 53 received placebo over a period of 4 weeks.

He and his associates compared the two groups of children to see whether the methylphenidate improved children's social skills, classroom behavior, and ratings of parenting stress.

At baseline and at week 4, the investigators administered the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) scale, the Social Competence Scale (SCS), the Parenting Stress Index (PSI), and the Clinical Global Impression-Severity (CGI-S) scale.

Of the 114 children, 24 in the placebo group and 9 in the treatment group dropped out because their behavior deteriorated, said Dr. Abikoff, who directs the Institute for Attention Deficit and Hyperactivity and Behavior Disorders at New York University, New York. Two others declined study participation and one had medication-related side effects, resulting in a total of 36 children who dropped out of the study.

Dr. Abikoff reported that the placebo and treatment groups did not differ significantly in the parents' ratings for the SWAN, SCS, and PSI, or in the SWAN teacher ratings. However, the children's teachers rated children in the treatment group as significantly improved on the SCS, compared with their peers in the placebo group.

“The teachers were picking up something,” Dr. Abikoff said at the meeting. “Is that because teachers had an opportunity to judge a child's social functioning, compared to hundreds of other children they've worked with, and also because they're seeing that child interact with many children day in and day out, whereas parents are limited in what they're able to see?”

He also noted that results of the clinician CGI-S ratings showed significantly more improvement among children in the treatment group, compared with those in the placebo group.

Dr. Abikoff said the findings underscore “the need for multiple informants when you're working with children with ADHD, regardless of their age, but certainly when they're in the preschool range.

SAN DIEGO — Preschool children with attention-deficit hyperactivity disorder who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with children who had fewer comorbid disorders, a randomized study shows.

Dr. Jaswinder K. Ghuman reported the findings of a secondary analysis of the National Institute of Mental Health Preschool and Treatment Study (PATS) at the annual meeting of the American Academy of Child and Adolescent Psychiatry. Dr. Ghuman and her associates examined baseline characteristics of methylphenidate treatment response in 165 children aged 3.5–5 years who were randomized to methylphenidate over a 5-week period. The doses ranged from 7.5 mg/day to 22 mg/day.

Of the 165 children, 47 (28%) had no comorbid disorder, 69 (42%) had 2 comorbid disorders, and 15 (9%) had 3–4 comorbid disorders, reported Dr. Ghuman, who directs the infant and preschool program in the division of child and adolescent psychiatry at the University of Arizona in Tucson. Oppositional defiant disorder was the most common comorbid disorder, followed by communication disorders and anxiety disorder.

She and her associates found that study participants who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with those who had two, one, or no comorbid disorders. They also found no evidence that age, ethnicity, gender, intelligence quotient, ADHD subtype and severity, or the mother's education level influenced treatment outcome.

In a separate presentation at the meeting, Howard Abikoff, Ph.D., discussed a subset analysis of 114 children in the PATS who improved with methylphenidate treatment. Of the 114 children, 61 received methylphenidate and 53 received placebo over a period of 4 weeks.

He and his associates compared the two groups of children to see whether methylphenidate improved children's social skills, classroom behavior, and ratings of parenting stress. At baseline and at week 4, they administered the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) scale, the Social Competence Scale (SCS), the Parenting Stress Index (PSI), and the Clinical Global Impression-Severity (CGI-S) scale.

Of the 114 children, 24 in the placebo group and 9 in the treatment group dropped out because their behavior deteriorated, said Dr. Abikoff, who directs the Institute for Attention Deficit and Hyperactivity and Behavior Disorders at New York University, New York.

Dr. Abikoff reported that the placebo and treatment groups did not differ significantly in the parent SWAN, SCS, and PSI ratings, or in the SWAN teacher ratings. However, teachers rated children in the treatment group as significantly improved on the SCS, compared with their peers in the placebo group.

SAN DIEGO — Preschool children with attention-deficit hyperactivity disorder who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with children who had fewer comorbid disorders, a randomized study shows.

Dr. Jaswinder K. Ghuman reported the findings of a secondary analysis of the National Institute of Mental Health Preschool and Treatment Study (PATS) at the annual meeting of the American Academy of Child and Adolescent Psychiatry. Dr. Ghuman and her associates examined baseline characteristics of methylphenidate treatment response in 165 children aged 3.5–5 years who were randomized to methylphenidate over a 5-week period. The doses ranged from 7.5 mg/day to 22 mg/day.

Of the 165 children, 47 (28%) had no comorbid disorder, 69 (42%) had 2 comorbid disorders, and 15 (9%) had 3–4 comorbid disorders, reported Dr. Ghuman, who directs the infant and preschool program in the division of child and adolescent psychiatry at the University of Arizona in Tucson. Oppositional defiant disorder was the most common comorbid disorder, followed by communication disorders and anxiety disorder.

She and her associates found that study participants who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with those who had two, one, or no comorbid disorders. They also found no evidence that age, ethnicity, gender, intelligence quotient, ADHD subtype and severity, or the mother's education level influenced treatment outcome.

In a separate presentation at the meeting, Howard Abikoff, Ph.D., discussed a subset analysis of 114 children in the PATS who improved with methylphenidate treatment. Of the 114 children, 61 received methylphenidate and 53 received placebo over a period of 4 weeks.

He and his associates compared the two groups of children to see whether methylphenidate improved children's social skills, classroom behavior, and ratings of parenting stress. At baseline and at week 4, they administered the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) scale, the Social Competence Scale (SCS), the Parenting Stress Index (PSI), and the Clinical Global Impression-Severity (CGI-S) scale.

Of the 114 children, 24 in the placebo group and 9 in the treatment group dropped out because their behavior deteriorated, said Dr. Abikoff, who directs the Institute for Attention Deficit and Hyperactivity and Behavior Disorders at New York University, New York.

Dr. Abikoff reported that the placebo and treatment groups did not differ significantly in the parent SWAN, SCS, and PSI ratings, or in the SWAN teacher ratings. However, teachers rated children in the treatment group as significantly improved on the SCS, compared with their peers in the placebo group.

SAN DIEGO — Preschool children with attention-deficit hyperactivity disorder who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with children who had fewer comorbid disorders, a randomized study shows.

Dr. Jaswinder K. Ghuman reported the findings of a secondary analysis of the National Institute of Mental Health Preschool and Treatment Study (PATS) at the annual meeting of the American Academy of Child and Adolescent Psychiatry. Dr. Ghuman and her associates examined baseline characteristics of methylphenidate treatment response in 165 children aged 3.5–5 years who were randomized to methylphenidate over a 5-week period. The doses ranged from 7.5 mg/day to 22 mg/day.

Of the 165 children, 47 (28%) had no comorbid disorder, 69 (42%) had 2 comorbid disorders, and 15 (9%) had 3–4 comorbid disorders, reported Dr. Ghuman, who directs the infant and preschool program in the division of child and adolescent psychiatry at the University of Arizona in Tucson. Oppositional defiant disorder was the most common comorbid disorder, followed by communication disorders and anxiety disorder.

She and her associates found that study participants who had three or more comorbid disorders responded less favorably to 5 weeks of methylphenidate treatment, compared with those who had two, one, or no comorbid disorders. They also found no evidence that age, ethnicity, gender, intelligence quotient, ADHD subtype and severity, or the mother's education level influenced treatment outcome.

In a separate presentation at the meeting, Howard Abikoff, Ph.D., discussed a subset analysis of 114 children in the PATS who improved with methylphenidate treatment. Of the 114 children, 61 received methylphenidate and 53 received placebo over a period of 4 weeks.

He and his associates compared the two groups of children to see whether methylphenidate improved children's social skills, classroom behavior, and ratings of parenting stress. At baseline and at week 4, they administered the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) scale, the Social Competence Scale (SCS), the Parenting Stress Index (PSI), and the Clinical Global Impression-Severity (CGI-S) scale.

Of the 114 children, 24 in the placebo group and 9 in the treatment group dropped out because their behavior deteriorated, said Dr. Abikoff, who directs the Institute for Attention Deficit and Hyperactivity and Behavior Disorders at New York University, New York.

Dr. Abikoff reported that the placebo and treatment groups did not differ significantly in the parent SWAN, SCS, and PSI ratings, or in the SWAN teacher ratings. However, teachers rated children in the treatment group as significantly improved on the SCS, compared with their peers in the placebo group.

SAN FRANCISCO — The highest rates of invasive pneumococcal disease were seen in children younger than 2 years of age in a Massachusetts study, Dr. Katherine K. Hsu reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The results also showed that black and Hispanic children remain especially vulnerable to nonvaccine-type invasive pneumococcal disease (IPD), compared with white children.

Using microbiology reports of pneumococcal isolates from the Massachusetts Department of Public Health, the researchers identified 357 cases of IPD in children younger than 18 years of age between October 1, 2001, and September 30, 2005. Demographic data were confirmed with follow-up telephone interviews with primary care providers and/or adult caregivers. Incidence rates were derived using Census 2000 denominators.

Dr. Hsu and her associates found that the relative risk of IPD was 15.9 for children younger than 6 months, 16.8 for those aged 6–12 months, and 12.7 for those aged 12–24 months, compared with a relative risk of only 4.5 for children aged 24–60 months. Dr. Hsu did not give any data on older children.

The researchers also found that black and Hispanic children were two times more likely than their white counterparts to have IPD, particularly the nonvaccine type. Dr. Hsu, of the section of pediatric infectious diseases at Boston Medical Center, noted that these differences could not be attributed to unequal vaccination coverage rates. Rather, she said, black and Hispanic children appear to be particularly vulnerable to disease from serotypes not included in the pneumococcal conjugate (PCV7) vaccine.

The study was supported by Wyeth.

SAN FRANCISCO — The highest rates of invasive pneumococcal disease were seen in children younger than 2 years of age in a Massachusetts study, Dr. Katherine K. Hsu reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The results also showed that black and Hispanic children remain especially vulnerable to nonvaccine-type invasive pneumococcal disease (IPD), compared with white children.

Using microbiology reports of pneumococcal isolates from the Massachusetts Department of Public Health, the researchers identified 357 cases of IPD in children younger than 18 years of age between October 1, 2001, and September 30, 2005. Demographic data were confirmed with follow-up telephone interviews with primary care providers and/or adult caregivers. Incidence rates were derived using Census 2000 denominators.

Dr. Hsu and her associates found that the relative risk of IPD was 15.9 for children younger than 6 months, 16.8 for those aged 6–12 months, and 12.7 for those aged 12–24 months, compared with a relative risk of only 4.5 for children aged 24–60 months. Dr. Hsu did not give any data on older children.

The researchers also found that black and Hispanic children were two times more likely than their white counterparts to have IPD, particularly the nonvaccine type. Dr. Hsu, of the section of pediatric infectious diseases at Boston Medical Center, noted that these differences could not be attributed to unequal vaccination coverage rates. Rather, she said, black and Hispanic children appear to be particularly vulnerable to disease from serotypes not included in the pneumococcal conjugate (PCV7) vaccine.

The study was supported by Wyeth.

SAN FRANCISCO — The highest rates of invasive pneumococcal disease were seen in children younger than 2 years of age in a Massachusetts study, Dr. Katherine K. Hsu reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The results also showed that black and Hispanic children remain especially vulnerable to nonvaccine-type invasive pneumococcal disease (IPD), compared with white children.

Using microbiology reports of pneumococcal isolates from the Massachusetts Department of Public Health, the researchers identified 357 cases of IPD in children younger than 18 years of age between October 1, 2001, and September 30, 2005. Demographic data were confirmed with follow-up telephone interviews with primary care providers and/or adult caregivers. Incidence rates were derived using Census 2000 denominators.

Dr. Hsu and her associates found that the relative risk of IPD was 15.9 for children younger than 6 months, 16.8 for those aged 6–12 months, and 12.7 for those aged 12–24 months, compared with a relative risk of only 4.5 for children aged 24–60 months. Dr. Hsu did not give any data on older children.

The researchers also found that black and Hispanic children were two times more likely than their white counterparts to have IPD, particularly the nonvaccine type. Dr. Hsu, of the section of pediatric infectious diseases at Boston Medical Center, noted that these differences could not be attributed to unequal vaccination coverage rates. Rather, she said, black and Hispanic children appear to be particularly vulnerable to disease from serotypes not included in the pneumococcal conjugate (PCV7) vaccine.

The study was supported by Wyeth.

SAN FRANCISCO — Human meta-pneumovirus emerged as the second most common virus detected during a 4-year study of young children with alveolar pneumonia who are admitted to the emergency room, Dr. Dana G. Wolf reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

This particular finding is important because while an association between human metapneumovirus (hMPV) and bronchiolitis has been documented, “the involvement of hMPV in pneumonia remains unknown,” said Dr. Wolf, head of clinical virology in the department of clinical microbiology and infectious diseases at Hadassah University Hospital, Jerusalem.

She and her associates prospectively obtained nasal wash specimens from 1,296 children aged 5 years or younger who were admitted to the emergency room with alveolar pneumonia and from 136 age-matched controls who were admitted for elective surgery between November 2001 and October 2005.

The researchers used real-time polymerase chain reaction (PCR) to test for the presence of hMPV, and they used direct immunofluorescence or real time PCR to test for respiratory syncytial virus (RSV), adenovirus parainfluenza, and influenza viruses.

Dr. Wolf reported that of the children tested, hMPV was detected in 108 (8.3%) of the children admitted with alveolar pneumonia, compared with only 3 (2.2%) of the controls. hMPV was the second most common viral pathogen after RSV (23.1%), followed by adenovirus (3.4%), parainfluenza (2.9%), and influenza A (2.9%).

Most hMPV infections (88%) occurred between November and May, and hMPV was the second most common virus in each of the 4 years in this particular study.

Specifically, hMPV was detected between November and May in 14.5% of patients in year 1; 5.8% of patients in year 2; 6.2% of patients in year 3, and 12.2% of patients in year 4.

The researchers observed differences in the rates of RSV infection by age. Specifically, 37% of children younger than 1 year of age were infected with RSV, compared with 11% of those aged 1 year and older.

By contrast, the rates of hMPV infection remained the same among both age groups (6.5%).

“The important role of hMPV in community-acquired alveolar pneumonia, usually considered to be of bacterial origin, supports the notion of hMPV-bacterial coinfection as suggested by vaccine probe studies,” Dr. Wolf said at the meeting, sponsored by the American Society for Microbiology.

SAN FRANCISCO — Human meta-pneumovirus emerged as the second most common virus detected during a 4-year study of young children with alveolar pneumonia who are admitted to the emergency room, Dr. Dana G. Wolf reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

This particular finding is important because while an association between human metapneumovirus (hMPV) and bronchiolitis has been documented, “the involvement of hMPV in pneumonia remains unknown,” said Dr. Wolf, head of clinical virology in the department of clinical microbiology and infectious diseases at Hadassah University Hospital, Jerusalem.

She and her associates prospectively obtained nasal wash specimens from 1,296 children aged 5 years or younger who were admitted to the emergency room with alveolar pneumonia and from 136 age-matched controls who were admitted for elective surgery between November 2001 and October 2005.

The researchers used real-time polymerase chain reaction (PCR) to test for the presence of hMPV, and they used direct immunofluorescence or real time PCR to test for respiratory syncytial virus (RSV), adenovirus parainfluenza, and influenza viruses.

Dr. Wolf reported that of the children tested, hMPV was detected in 108 (8.3%) of the children admitted with alveolar pneumonia, compared with only 3 (2.2%) of the controls. hMPV was the second most common viral pathogen after RSV (23.1%), followed by adenovirus (3.4%), parainfluenza (2.9%), and influenza A (2.9%).

Most hMPV infections (88%) occurred between November and May, and hMPV was the second most common virus in each of the 4 years in this particular study.

Specifically, hMPV was detected between November and May in 14.5% of patients in year 1; 5.8% of patients in year 2; 6.2% of patients in year 3, and 12.2% of patients in year 4.

The researchers observed differences in the rates of RSV infection by age. Specifically, 37% of children younger than 1 year of age were infected with RSV, compared with 11% of those aged 1 year and older.

By contrast, the rates of hMPV infection remained the same among both age groups (6.5%).

“The important role of hMPV in community-acquired alveolar pneumonia, usually considered to be of bacterial origin, supports the notion of hMPV-bacterial coinfection as suggested by vaccine probe studies,” Dr. Wolf said at the meeting, sponsored by the American Society for Microbiology.

SAN FRANCISCO — Human meta-pneumovirus emerged as the second most common virus detected during a 4-year study of young children with alveolar pneumonia who are admitted to the emergency room, Dr. Dana G. Wolf reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

This particular finding is important because while an association between human metapneumovirus (hMPV) and bronchiolitis has been documented, “the involvement of hMPV in pneumonia remains unknown,” said Dr. Wolf, head of clinical virology in the department of clinical microbiology and infectious diseases at Hadassah University Hospital, Jerusalem.

She and her associates prospectively obtained nasal wash specimens from 1,296 children aged 5 years or younger who were admitted to the emergency room with alveolar pneumonia and from 136 age-matched controls who were admitted for elective surgery between November 2001 and October 2005.

The researchers used real-time polymerase chain reaction (PCR) to test for the presence of hMPV, and they used direct immunofluorescence or real time PCR to test for respiratory syncytial virus (RSV), adenovirus parainfluenza, and influenza viruses.

Dr. Wolf reported that of the children tested, hMPV was detected in 108 (8.3%) of the children admitted with alveolar pneumonia, compared with only 3 (2.2%) of the controls. hMPV was the second most common viral pathogen after RSV (23.1%), followed by adenovirus (3.4%), parainfluenza (2.9%), and influenza A (2.9%).

Most hMPV infections (88%) occurred between November and May, and hMPV was the second most common virus in each of the 4 years in this particular study.

Specifically, hMPV was detected between November and May in 14.5% of patients in year 1; 5.8% of patients in year 2; 6.2% of patients in year 3, and 12.2% of patients in year 4.

The researchers observed differences in the rates of RSV infection by age. Specifically, 37% of children younger than 1 year of age were infected with RSV, compared with 11% of those aged 1 year and older.

By contrast, the rates of hMPV infection remained the same among both age groups (6.5%).

“The important role of hMPV in community-acquired alveolar pneumonia, usually considered to be of bacterial origin, supports the notion of hMPV-bacterial coinfection as suggested by vaccine probe studies,” Dr. Wolf said at the meeting, sponsored by the American Society for Microbiology.

SAN FRANCISCO — Preliminary results from a European study suggest that the appropriate time for pertussis booster administration after school age may differ according to local factors such as circulation of the disease, the type of vaccine, and the vaccine schedule in use, Dr. Alberto Tozzi reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy sponsored by the American Society for Microbiology.

“Now that the United States has recommended a booster dose in adolescents, every country in Europe will try to follow the same recommendation,” Dr. Tozzi of Bambino Gesù Hospital in Rome said in an interview. “This, to me, is not appropriate, because there are different patterns and scenarios that need to be accurately investigated.”

He and his associates used the pertussis screening method in 16 European countries and World Health Organization data to calculate vaccine efficacy by age and vaccination cohort between 1998 and 2002. The countries included in the study were Austria, Denmark, France, Germany, Greece, Iceland, Ireland, Italy, Malta, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom.

The researchers found that the pertussis vaccine efficacy exceeded 80% in each of the countries except Sweden and Norway. The immunization schedules in those Scandinavian countries, he said, do not include administration of a booster dose at school age. As a result, “they experience a big increase of cases after that age, because immunity induced by the immunization does not last that long,” Dr. Tozzi said.

On the other hand, in Italy and France, where the vaccination schedule includes a booster dose at school age, the efficacy against pertussis was sustained until adolescence.

The type of vaccine matters, too. In the Netherlands, for example, clinicians currently use the cellular form of the pertussis vaccine. As a result, Dr. Tozzi noted, efficacy is maintained only for a few years.

“Looking at all this data, you must take into account the background coverage for pertussis, the type of vaccine used, and the schedule,” he said. “All of these things must be looked at before deciding which kind of booster dose is to be given” and when.

He and his associates are collecting more data from these 16 countries in an effort to correctly plan the appropriate time to administer a booster dose of vaccine. The study is part of the Euvac.net project, an ongoing effort to monitor and control vaccine-preventable diseases in Europe, funded by the European Parliament and Council.

'You must take into account the background coverage for pertussis, the type of vaccine used, and the schedule.' DR. TOZZI

SAN FRANCISCO — Preliminary results from a European study suggest that the appropriate time for pertussis booster administration after school age may differ according to local factors such as circulation of the disease, the type of vaccine, and the vaccine schedule in use, Dr. Alberto Tozzi reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy sponsored by the American Society for Microbiology.

“Now that the United States has recommended a booster dose in adolescents, every country in Europe will try to follow the same recommendation,” Dr. Tozzi of Bambino Gesù Hospital in Rome said in an interview. “This, to me, is not appropriate, because there are different patterns and scenarios that need to be accurately investigated.”

He and his associates used the pertussis screening method in 16 European countries and World Health Organization data to calculate vaccine efficacy by age and vaccination cohort between 1998 and 2002. The countries included in the study were Austria, Denmark, France, Germany, Greece, Iceland, Ireland, Italy, Malta, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom.

The researchers found that the pertussis vaccine efficacy exceeded 80% in each of the countries except Sweden and Norway. The immunization schedules in those Scandinavian countries, he said, do not include administration of a booster dose at school age. As a result, “they experience a big increase of cases after that age, because immunity induced by the immunization does not last that long,” Dr. Tozzi said.

On the other hand, in Italy and France, where the vaccination schedule includes a booster dose at school age, the efficacy against pertussis was sustained until adolescence.

The type of vaccine matters, too. In the Netherlands, for example, clinicians currently use the cellular form of the pertussis vaccine. As a result, Dr. Tozzi noted, efficacy is maintained only for a few years.

“Looking at all this data, you must take into account the background coverage for pertussis, the type of vaccine used, and the schedule,” he said. “All of these things must be looked at before deciding which kind of booster dose is to be given” and when.

He and his associates are collecting more data from these 16 countries in an effort to correctly plan the appropriate time to administer a booster dose of vaccine. The study is part of the Euvac.net project, an ongoing effort to monitor and control vaccine-preventable diseases in Europe, funded by the European Parliament and Council.

'You must take into account the background coverage for pertussis, the type of vaccine used, and the schedule.' DR. TOZZI

SAN FRANCISCO — Preliminary results from a European study suggest that the appropriate time for pertussis booster administration after school age may differ according to local factors such as circulation of the disease, the type of vaccine, and the vaccine schedule in use, Dr. Alberto Tozzi reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy sponsored by the American Society for Microbiology.

“Now that the United States has recommended a booster dose in adolescents, every country in Europe will try to follow the same recommendation,” Dr. Tozzi of Bambino Gesù Hospital in Rome said in an interview. “This, to me, is not appropriate, because there are different patterns and scenarios that need to be accurately investigated.”

He and his associates used the pertussis screening method in 16 European countries and World Health Organization data to calculate vaccine efficacy by age and vaccination cohort between 1998 and 2002. The countries included in the study were Austria, Denmark, France, Germany, Greece, Iceland, Ireland, Italy, Malta, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom.

The researchers found that the pertussis vaccine efficacy exceeded 80% in each of the countries except Sweden and Norway. The immunization schedules in those Scandinavian countries, he said, do not include administration of a booster dose at school age. As a result, “they experience a big increase of cases after that age, because immunity induced by the immunization does not last that long,” Dr. Tozzi said.

On the other hand, in Italy and France, where the vaccination schedule includes a booster dose at school age, the efficacy against pertussis was sustained until adolescence.

The type of vaccine matters, too. In the Netherlands, for example, clinicians currently use the cellular form of the pertussis vaccine. As a result, Dr. Tozzi noted, efficacy is maintained only for a few years.

“Looking at all this data, you must take into account the background coverage for pertussis, the type of vaccine used, and the schedule,” he said. “All of these things must be looked at before deciding which kind of booster dose is to be given” and when.

He and his associates are collecting more data from these 16 countries in an effort to correctly plan the appropriate time to administer a booster dose of vaccine. The study is part of the Euvac.net project, an ongoing effort to monitor and control vaccine-preventable diseases in Europe, funded by the European Parliament and Council.

'You must take into account the background coverage for pertussis, the type of vaccine used, and the schedule.' DR. TOZZI

SAN FRANCISCO — An analysis of a pertussis outbreak at a day care center in Israel revealed that the efficacy of the acellular pertussis vaccine in children who were vaccinated was 93%, Dr. Ellen S. Bamberger reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy sponsored by the American Society for Microbiology.

“When we look at the distribution of children who actually got pertussis, the pertussis vaccine actually protects, and the children who are unvaccinated in an outbreak setting are much more likely to be infected, and their clinical symptoms tend to be more severe,” Dr. Bamberger of the B'nai Zion Medical Center in Haifa, Israel, said in an interview.

She and her associates investigated 31 children aged 3–5.5 years who were exposed to a child with pertussis at a day care center in Haifa. Parents of the children filled out questionnaires about symptoms and immunization status, and the researchers obtained nasopharyngeal swabs for Bordetella pertussis and polymerase chain reaction (PCR) testing that targeted the pertussis toxin.

They conducted follow-up exams at 21 days and obtained repeat samples in symptomatic children.

Of the 31 children, 6 (19%) tested positive for pertussis by PCR. Only 2 of the 27 children (7%) who had been vaccinated against the disease tested positive for pertussis, compared with each of the 4 children who had not received a vaccination (100%). Dr. Bamberger and her associates calculated the vaccine to be 93% efficacious.

Azithromycin chemoprophylaxis was recommended for all exposed children but only 15 of the 25 exposed children (56%) took azithromycin. The dose was 10 mg/kg on the first day followed by 5 mg/kg for 4 days.

At 21-day follow-up, 2 of the 6 children with laboratory-confirmed pertussis (33%) reported a mild residual cough and 5 of the 25 exposed children (20%) had developed an upper respiratory tract infection with cough. Three of these 5 children (60%) had completed azithromycin prophylaxis. There were no further cases of laboratory-diagnosed pertussis in any of the exposed children, regardless of whether chemoprophylaxis was taken or not.

“Chemoprophylaxis with azithro-mycin did not appear to afford any added benefit in thwarting the development of pertussis among recently vaccinated children exposed to a pertussis outbreak,” the researchers wrote in their poster.

“Our findings confirm the high efficacy and importance of the acellular pertussis vaccine in day care children, and despite the limited number of subjects in the study, raise questions about the added value of chemoprophylaxis in this age group.”

SAN FRANCISCO — An analysis of a pertussis outbreak at a day care center in Israel revealed that the efficacy of the acellular pertussis vaccine in children who were vaccinated was 93%, Dr. Ellen S. Bamberger reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy sponsored by the American Society for Microbiology.

“When we look at the distribution of children who actually got pertussis, the pertussis vaccine actually protects, and the children who are unvaccinated in an outbreak setting are much more likely to be infected, and their clinical symptoms tend to be more severe,” Dr. Bamberger of the B'nai Zion Medical Center in Haifa, Israel, said in an interview.

She and her associates investigated 31 children aged 3–5.5 years who were exposed to a child with pertussis at a day care center in Haifa. Parents of the children filled out questionnaires about symptoms and immunization status, and the researchers obtained nasopharyngeal swabs for Bordetella pertussis and polymerase chain reaction (PCR) testing that targeted the pertussis toxin.

They conducted follow-up exams at 21 days and obtained repeat samples in symptomatic children.

Of the 31 children, 6 (19%) tested positive for pertussis by PCR. Only 2 of the 27 children (7%) who had been vaccinated against the disease tested positive for pertussis, compared with each of the 4 children who had not received a vaccination (100%). Dr. Bamberger and her associates calculated the vaccine to be 93% efficacious.

Azithromycin chemoprophylaxis was recommended for all exposed children but only 15 of the 25 exposed children (56%) took azithromycin. The dose was 10 mg/kg on the first day followed by 5 mg/kg for 4 days.

At 21-day follow-up, 2 of the 6 children with laboratory-confirmed pertussis (33%) reported a mild residual cough and 5 of the 25 exposed children (20%) had developed an upper respiratory tract infection with cough. Three of these 5 children (60%) had completed azithromycin prophylaxis. There were no further cases of laboratory-diagnosed pertussis in any of the exposed children, regardless of whether chemoprophylaxis was taken or not.

“Chemoprophylaxis with azithro-mycin did not appear to afford any added benefit in thwarting the development of pertussis among recently vaccinated children exposed to a pertussis outbreak,” the researchers wrote in their poster.

“Our findings confirm the high efficacy and importance of the acellular pertussis vaccine in day care children, and despite the limited number of subjects in the study, raise questions about the added value of chemoprophylaxis in this age group.”

SAN FRANCISCO — An analysis of a pertussis outbreak at a day care center in Israel revealed that the efficacy of the acellular pertussis vaccine in children who were vaccinated was 93%, Dr. Ellen S. Bamberger reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy sponsored by the American Society for Microbiology.

“When we look at the distribution of children who actually got pertussis, the pertussis vaccine actually protects, and the children who are unvaccinated in an outbreak setting are much more likely to be infected, and their clinical symptoms tend to be more severe,” Dr. Bamberger of the B'nai Zion Medical Center in Haifa, Israel, said in an interview.

She and her associates investigated 31 children aged 3–5.5 years who were exposed to a child with pertussis at a day care center in Haifa. Parents of the children filled out questionnaires about symptoms and immunization status, and the researchers obtained nasopharyngeal swabs for Bordetella pertussis and polymerase chain reaction (PCR) testing that targeted the pertussis toxin.

They conducted follow-up exams at 21 days and obtained repeat samples in symptomatic children.

Of the 31 children, 6 (19%) tested positive for pertussis by PCR. Only 2 of the 27 children (7%) who had been vaccinated against the disease tested positive for pertussis, compared with each of the 4 children who had not received a vaccination (100%). Dr. Bamberger and her associates calculated the vaccine to be 93% efficacious.

Azithromycin chemoprophylaxis was recommended for all exposed children but only 15 of the 25 exposed children (56%) took azithromycin. The dose was 10 mg/kg on the first day followed by 5 mg/kg for 4 days.

At 21-day follow-up, 2 of the 6 children with laboratory-confirmed pertussis (33%) reported a mild residual cough and 5 of the 25 exposed children (20%) had developed an upper respiratory tract infection with cough. Three of these 5 children (60%) had completed azithromycin prophylaxis. There were no further cases of laboratory-diagnosed pertussis in any of the exposed children, regardless of whether chemoprophylaxis was taken or not.

“Chemoprophylaxis with azithro-mycin did not appear to afford any added benefit in thwarting the development of pertussis among recently vaccinated children exposed to a pertussis outbreak,” the researchers wrote in their poster.

“Our findings confirm the high efficacy and importance of the acellular pertussis vaccine in day care children, and despite the limited number of subjects in the study, raise questions about the added value of chemoprophylaxis in this age group.”