We appreciate Dr Sunder's thoughtful comments concerning our article. His letter concentrates on three major points: (1) the frequency of seizures as the initial symptom of childhood moyamoya disease, (2) whether the stereotyped spells described in our report represent seizures or transient ischemic attacks, and (3) whether these spells were secondary to underlying vascular disease. We shall attempt to address each of these issues.After studying the patient described in our report, we made what we consider to be a fairly exhaustive review of the literature available to us. Searches of the Index Medicus and the Medlars /Medline computerized bibliographic system of the National Library of Medicine were carried out. Each article so obtained was reviewed for details of the cases reported as well as for possible additional references. Unfortunately, neither the review appearing in the Handbook of Clinical Neurology2 and mentioned by Dr Sunder nor Dr Sunder's
Schoenberg BS, Mellinger JF. Moyamoya Disease-Reply. Arch Neurol. 1979;36(1):60–61. doi:10.1001/archneur.1979.00500370090032
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