S64 Posters moderate delay prior to the seizure onset 68% had moderate to severe developmental outcome. 13/27 had relapse of hypsarythmia, with a majority of them − 82.3% having mild to severe psychomotor regression at 2yr of age and only 53% seizure free. Relapse of hypsarythmia appeared to be significant predictor of severe epilepsy and poor neurodevelopmental outcome (p < 0.05). Conclusion: Outcome was worse for patients with symp- tomatic west syndrome, early onset of infantile spasms and relapse of hypsarythmia P141 Retention rates of new antiepiletic drugs in Hong Kong Chinese − a single center study L.W.E. Fung 1 *. 1 Paediatrics, The Chinese University of Hong Kong, Hong Kong Objective: To study the long-term retention rates of new antiepileptic drugs in children (i.e., those less than 18 years at age of commencement of drugs). Methods: Patients were retrospectively retrieved from database in a tertiary centre for patients taking newer antiepileptic drugs available in the Hong Kong (including lamotrigine, topiramate and levitarecetam). We reviewed their medical records to retrieve their demographic data, date of onset of epilepsy, date of commencement of the antiepileptics, outcome, date and reason of stopping the antiepileptic drugs, etc. Kaplan-Meier Method was used to obtain the product-limit estimate of the retention rate of each drug. Results: 66, 30 and 32 patients were prescribed lamotrigine, topiramate and levitarecetam respectively. 90% of patients taking levitarecetam started from year 2007 onward. Three- year retention rate for these drugs was 70% and 34% for lamotrigine and topiramate respectively. Number of patients who discontinued after three years was 18 for lamotrigine and 20 for topiramate. 22% patients on lamotrigine, 43% on topiramate and 14% on levitarecetam stopped drugs because of adverse events. 48%, 42% and 85% stopped drugs because of lack of efficacy (for lamotrigine, topiramate and levitarecetam respectively). 12-month retention for levitarecetam was comparable to that of lamotrigine. Conclusion: The long-term retention rate for lamotrigine in our group of children was comparable to that reported in adults, while that for topiramate was lower in our group. Adverse events were common in children taking topiramate. 12-month retention rate was levitarecetam was also comparable to other studies in adults. P142 Psychological intervention with a child experiencing reflex anoxic seizures: a case report E.J. Bennett 1,2 *, E. Meldrum 1 . 1 CAMHS, Nottinghamshire Healthcare NHS Trust; 2 Institute of Work Health and Organisations, University of Nottingham, UK Objectives: We describe the case of a ten-year old girl who experienced anoxic seizures in response to medical instruments and settings. The girl was referred to Clinical Psychology and received around fifteen weekly sessions of therapy. We summarise the key strategies and principles of the intervention and outline the positive impact of the work on both the girl and her family. Methods: Intervention utilised an integrated approach including psychoeducation about anxiety, graded exposure to feared stimuli (eg blood pressure monitors), family work, and the use of narrative therapy techniques. It particularly focused on enhancing the girl’s ability to cope with triggers and the reduction of unhelpful avoidance behaviours. Results: By the end of the initial treatment phase, the girl was able to have her blood pressure taken by a nurse, tolerate medical settings and watch procedures on the television. Despite increased contact with triggers, she had not experienced any seizures since starting therapy. Both the girl and her parents reported large reductions in anxiety about seizures and increases in their belief in her ability to cope. Standardised measures reflected a fall in the girl’s anxiety and depression levels, and in her mother’s parenting stress levels. Conclusions: In this case, psychological intervention offered effective support in the management of anoxic seizures. Techniques can be used to reduce the frequency of seizures, to enhance self-efficacy and to lower family anxiety levels. Medical professionals should consider referring children experiencing reflex anoxic seizures and their parents for psychological assessment, intervention and support. P143 Late-onset epileptic spasms in children with Pallister Killian syndrome: two new cases and review of the electroclinical aspects C. Cerminara 1 , E. Compagnone 1 , V. Bagnolo 1 , C. Galasso 1 , A. Lo-Castro 1 , P. Curatolo 1 *. 1 Child Neurology Unit, Department of Neuroscience, “Tor Vergata” University of Rome, Italy Objective: To describe two cases of late onset epileptic spasms in patients affected by Pallister Killian Syndrome (PKS) and to study the predictive value of Video-electroencephalographic recording and polygraphic study. Methods: For the cytogenetic analysis, G-banding karyotype analysis was performed on skin fibroblast cultures; then the diagnosis was confirmed by Fluorescent in situ hybridization (FISH) analyses using a chromosome 12-specific painting probe. Subsequently we have performed Video-EEG recording with polygraphic channels to demonstrate the ictal and interictal activity of our patients. Results: Our patients presented brief asymmetrical spasm respectively at 4 2 / 12 years of age and at 6 7 / 12 years of age. The ictal electroencephalography showed a generalized slow wave at the beginning of each spasm, followed by fast activity. During the spasms, in patients nº1, two electrodes (R Delt, L Delt) showed bilateral deltoid muscle activity characterized by “diamond-shaped” bursts, corresponding to left deltoid contractions with rapid onset and slower offset. Conclusions: Epileptic seizures were reported in 40% of 67 cases of PKS but only few, undetailed data exist on the types of epileptic seizures associated with Pallister Killian syndrome, especially regarding epileptic spasms. Recently three patients with PKS have been described with late onset epileptic spasms. Other more detailed studies, which include appropriate polygraphic tests (video- electroencephalography, electromyography), are needed in order to clarify the electroclinical features of seizures in Pallister Killian syndrome, thereby allowing an early diagnosis and specific treatment. In addition chromosomal regions where aberrations have an evident association with epilepsy may be useful targets for gene hunters. Genetic analyses like fluorescent in situ hybridization with specific probes are useful to define chromosomal breakpoints and the extent of aberrations, thus leading to better genotype- phenotype correlations. P144 Absence of seizures in a case of Wolf Hirschhorn syndrome with LETM1 deletion C. Galasso 1 , A. Lo-Castro 1 , N. El-Malhany 1 , L. Di Carlo 1 , C. Cerminara 1 , M. Zollino 2 , P. Curatolo 1 *. 1 Department of Neuroscience, Pediatric Neurology Unit, “Tor Vergata” University of Rome, Italy; 2 Department of Medical Genetics, Catholic University of Rome, Italy Objectives: To delineate a genotype-phenotype correlation in Wolf-Hirschhorn syndrome (WHS). We describe the first case of a “mild” complete WHS phenotype caused by a de novo