Comment. The authors wisely add a footnote, albeit in small print, to these reports that their recommendations do not indicate an exclusive course of treatment or procedure to be followed and that variations, taking into account individual circumstances, may be appropriate. The dangers of measles encephalitis and its sequelae in unimmunized children far outweigh the risks of vaccine-induced seizures, and the committee recommendation for measles vaccine is sound. Children suffering from epilepsy should be examined by a neurologist before immunization as a precaution and anticonvulsant drug levels should be adjusted to optimal therapeutic amounts when necessary.

Regarding pertussis immunization, the statement that “there is no reason to treat children with a family history of convulsive disorder or of “neurologic disease” any differently from children without such a history” may be misleading without qualification. Again, a pediatrician may be well advised to consult the neurologist caring for a sibling or parent with epilepsy to determine the etiology of the seizures and the degree of familial susceptibility before proceeding with DPT immunization in an infant at increased risk.

The debate concerning DPT vaccine-induced encephalopathy continues in the courts [2] with experts quoted as favoring and others opposing a causal relation. In my experience of 14 cases of DPT-related seizure disorders evaluated in the past three years, 6 had infantile spasms with onset temporally related to the immunization. [3]