Coarse Facies, Calvarial Thickening and Hyperphosphatasia Associated with Long-Term Anticonvulsant Therapy

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Abstract
GROSS enlargement of the lips and nose and a generalized thickening of subcutaneous tissues of the face and scalp in several residents in a state institution for the mentally retarded prompted a review of the total population (750). Persons with the coarse features were found only among the 222 residents with seizures. Of these, the facial changes were obvious in approximately V3, were questionable in V3, and were absent in the remaining V3. Early photographs, where available, showed normal facies. Figure 1 shows a moderately affected boy at the ages of four and 16 years. Despite acromegaloid features, the sizes of the . . .