We describe a 13-month-old girl who developed convulsive status during an episode of rotavirus gastroenteritis. Persistent disturbance of consciousness, recurrent seizures, slowing on EEG, high signal areas on diffusion-weighted MRI, and normal cerebrospinal fl uid confi rmed the diagnosis of encephalopathy. In addition, hepatosplenomegaly, cytopenias, and a histopathological fi nding of hemophagocytosis in bone marrow were all observed in this case, and these three conditions together meet the diagnosis of hemophagocytic lymphohistiocytosis. The patient improved after commencement of steroid pulse therapy. This case suggests that the pathogenesis of rotavirus-associated encephalopathy may share some basic pathophysiologic mechanisms with hemophagocytic lymphohistiocytosis.

Effects of spa therapy on psychological factors were examined in 15 patients with bronchial asthma (10 females and 5 males, mean age 55.0 years) by CMI (Cornell Medical Index), SDS (Selfrating Depression Scale), CAI (Comprehensive Asthma Inventory) and SD (Semantic Differential). The results of these psychological examinations were compared before and after spa therapy for 1-2 months.
1. In CMI, mean point of physical symptoms decreased from 37.7 before spa therapy to 29.7 after the therapy. Mean improvement rate of the symptoms was 73.3%. The mean improvement rate was observed in 60.0% of respiratory symptoms, 66.7% of CIJ symptoms and 46.7% in psychical symptoms.
2. In SDS, many patients showed more than 40 points, suggesting that they have depressive mental state. The mean point decreased from 42.9 to 40.7 by spa therapy.
3. In CAI, categories of mental state, extent of conditioning, suggestion, fear of expectation, dependency, frustration and flight into illness, were clearly improved by spa therapy.
4. It was shown in SD that character of patients changed with beneficial trend for therapy of asthma after spa therapy.
These results suggest that psychological disorders of patients with bronchial asthma are improved by spa therapy.

We report a childhood case of localization-related epilepsy manifesting frequent gelastic seizures, which were successfully treated with topiramate (TPM) monotherapy. The seizures were not associated with feelings of mirth. High-resolution three-tesla magnetic resonance imaging revealed no structural abnormality. Interictal 18F-fluorodeoxyglucose positron emission tomography showed hypometabolism over the entire right hemisphere. Single-photon emission computed tomography imaging, both ictal and interictal, demonstrated no significant findings. Interictal electroencephalography (EEG) showed paroxysms in the right frontal region. Ictal video EEG demonstrated diffuse attenuation, followed by fast activities and spike-wave complexes predominantly over the right hemisphere. At the ictal EEG onset, low amplitude paroxysmal fast activity was recorded over the F8-T4 region. The seizures were considered to have originated from the right frontal lobe. TPM monotherapy resulted in complete cessation of the seizure. We suggest that TPM should be considered as a valuable tool for treating childhood intractable gelastic seizures, which are not due to hypothalamic hamartoma.