ABSTRACT
Objective:To explore the seizure recurrence and prognosis of epilepsy in relapse after anti-epileptic drugs (AEDs) withdrawal, and the influencing factors for these conditions.Methods:From December 2009 to August 2018, patients from the Affiliated Brain Hospital of Nanjing Medical University who relapsed after AEDs withdrawal were collected and followed up for at least 18 months. The seizure recurrence and prognosis of these patients were prospectively observed. The Kaplan-Meier method was used for survival analysis. The associated risk factors of the second relapse in the enrolled patients were analyzed by multivariate Cox analysis. The included patients were divided into good prognosis group and poor prognosis group according to whether they had achieved seizure freedom for at least one year after the first relapse. A multivariate Cox regression model was used to analyze the independent risk factors affecting their prognosis.Results:A total of 56 patients with epilepsy in relapse after AEDS withdrawal were collected. The average follow-up period was 46.23 months (18-120 months) from the initial time of seizure recurrence, and 21 patients (37.5%) had the second seizure recurrence. The relapsing risk in patients who continued to be observed without adding AEDs was higher than those who were treated immediately with drugs [9/16 vs 30.0% (12/40)], but without statistically significant difference (χ2=2.220, P=0.071). The results of univariate analysis showed that focal seizures, seizure frequency more than once per month before remission and poly-drug therapy before AEDs withdrawal were associated with high risk of the second relapse. Poly-drug therapy was an independent risk factor for the second relapse by multivariate Cox analysis ( HR=3.383, 95% CI 1.257-9.105). Of the 56 patients with epilepsy in relapse after AEDs withdrawal, 47 patients (83.9%) had a good prognosis without seizure for at least one year, and of 33 patients who were followed up for three years or more, 26 (78.8%) had no seizure for at least two years. Between the group retreated immediately after the first recurrence and the group without immediate treatment [87.5% (35/40) vs 12/16],there were no statistically significant differences on the proportions of good prognosis (χ2=2.333, P=0.258). Univariate analysis showed that the course of epilepsy>6 months before initial treatment, the frequency of seizures>1/month before remission, symptomatic epilepsy and poly-drug therapy were associated with the poor prognosis. However, none of independent risk factors was found for the poor prognosis through the multivariate analysis. Conclusions:The prognosis of patients with epilepsy in relapse after AEDs withdrawal is well, and about 2/3 patients with epilepsy in relapse after AEDs withdrawal have no more seizure recurrences. The poly-drug therapy before AEDs withdrawal may be an independent risk factor for the second seizure relapse.
ABSTRACT
Objective To assess the efficacy of whole body diffusion weighted imaging (WB-DWI) in detecting pediatric primary and metastatic malignant tumor. Methods WB-DWI was performed in 62 healthy pediatric volunteers and 40 pediatric patients with confirmed malignant tumors. The healthy volunteers were divided into three groups: 0 to 12 months, more than 12 months to 5 years and more than 5 to 15 years. The characteristics of WB-DWI imaging were analyzed. McNemar test was used to compare the difference of detection on metastasis between WB-DWI and WB-DWI combined with MRI, CT. The mean apparent diffusion coefficient ( ADC ) values of primary tumors and metastases were measured by using paired t test and compared with those of corresponding body regions of control group. Results WB-DWI imaging shows that signal intensity of metaphysis gradually reduces with increasing age in the normal pediatric group. On WB-DWI primary malignant tumors showed 100％ (40/40) high signal intensity and metastases showed high signal intensity in 89.2％ (58/65) on WB-DWI, with a positive predictive value of 90. 6％ (58/64). The detecting rate for metastases increased to 95.4％ (62/65) when WB-DWI was combined with MRL/CT, with a positive predictive value of 95.4％ (62/65) there was no statistically significant difference ( x2 = 2. 25, P ＞ 0. 05 ). The ADC values of primary malignant tumor sites in head ( n = 5), liver(n=6), kidney(n=8), adrenal(n=ll) were (0.76 ±0. 19) ×10-3 , (0. 97 ±0.29) × 10-3,(0. 81 ±0. 12) × 10-3 and (0. 93 ±0. 28) × 10-3mm2/s and those of corresponding body regions of control group were (1.02 ±0. 11) × 10-3,(1.57 ±0.58) × 10-3, (1.19 ±0. 15) × 10-3 and (2.03 ±0.42) ×10-3mm2/s respectively, there were statistically significant difference( t values were 3.54,3. 84,7. 02 and 12. 57 ;P ＜ 0. 05 ). The A DC values of metastases sites in head ( n = 9 ), liver ( n = 13 ), kidney ( n = 17 ),bone(n =7) and lymph node(n =6) were (0. 88 ±0. 12) × 10-3, (0. 98 ±0. 10) × 10-3, (0. 89 ±0. 11 ) × 10-3, (0. 96 ±0. 15) × 10-3 and (0. 83 ±0. 14) × 10-3mm2/s, and those of corresponding body regions of control group were (1.01 ±0.09) × 10-3, (1.45 ±0.39) × 10-3, ( 1.31 ±0.27) × 10-3, ( 1.34 ±0. 20) × 10 -3 and ( 0. 99 ± 0. 08 ) × 10 -3 mm2/s, there were statistically significant difference ( t values 4. 09,45.50,6. 95,14. 00 and 9. 27 ;P ＜ 0. 05 ). Conclusions Increased signal intensity is more frequently observed in metaphysis of long bone in normal children on WB-DWI. With a high detection rate for primary and metastatic malignant tumors, WB-DWI combined with conventional CT; MRI can significantly improve their sensitivity.