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.

As a kind of nervous system disease,migraine is more common in female,and has the clinical characteristics of repeated attacks,it is of great significance with standardized treatment in the control of the attacks.Yong female patients with migraine during pregnancy and lactation stage will face lots of special problems because they must first consider the impact of treatment on the mother and fetus.Generally,non-drug therapy is recommended as a first-line treatment,if it is not sufficiently effective,paracetamol is recommended during the pregnancy or sporadic use of sumatriptan,NSAIDs is not recommended during the first or third trimester of pregnancy.Preventive therapy should only be considered in the most severe cases.This review summarized recent documents of the safety of the most used antimigraine medications during pregnancy and breastfeeding,in order to provide treatment recommendations in clinical practice.

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.

Objective To report 1 case of iatrogenic botulinum poisoning misdiagnosed as myasthenia gravis,to discuss the clinical manifestation,distinguishing feature and prognosis of iatrogenic botulinum poisoning combined with literature.Methods We briefly introduced one patient with botulinum toxin poisoning misdiagnosed as myasthenia gravis.A 26-year old female was admitted in June 2017 in Gaochun People's Hospital of Nanjing,who received two injections of botulinum toxin 500 U for a short period of time due to cosmetic needs,then she suffered from fatigue,chest distress,eyelid ptosis and other symptoms.The patient was once misdiagnosed as myasthenia gravis,but the results of neostigmine test and repeated nerve stimulation examination were negative.After careful examination of the body (mandibular swelling) and repeated medical history requiring,the final diagnosis was clarified.After the treatment such as fluid infusion for 10 days,her discomforts were relieved.The literature was retrieved from "US National Library of Medicine National Institutes of Health (Pubmed) "," China National Knowledge Infrastructure (CNKI)" and "Wanfang Medicine Data China Information",a total of 17 articles were included in the analysis,including 30 effective cases.We analyzed the general characteristics,clinical manifestations and prognosis of botulinum toxin injection.Results Of the 30 cases,28 cases (96.7％) were female,2 cases (3.0％) were male,aged from 3 to 80 years old.Most of them were botulinum toxin type A,except 2 cases unknown.The clinical onset began from the injection day to 3 weeks after injection.The duration of the disease lasted from 10 days to 6 months.Most of the prognosis was good after treatment.Conclusion Careful attention should be paid to the serious reaction of botulinum toxin to ensure safe medication use.

Objective To investigate the correlation and predictive effect of serum CD4+/CD8+T lympho-cyte ratio combined with magnetic resonance angiography(MRA)on recurrence of cerebral infarction.Meth-ods A total of 153 patients with acute cerebral infarction admitted to the Zhenjiang First People's Hospital from January 2021 to February 2022 were selected.CD4+/CD8+T lymphocyte ratio of patients was deter-mined,vascular stenosis score and collateral circulation filling score were evaluated by MRA.The patients were followed up for 1 year,including 34 patients with recurrent cerebral infarction as recurrent cerebral in-farction group,107 patients without recurrent cerebral infarction as the non-recurrent cerebral infarction group,12 patients were excluded due to other causes of loss of follow-up,and the receiver operating character-istic(ROC)curve for using the indicators to predict the recurrent cerebral infarction was drawn.Results The CD4+/CD8+T lymphocyte ratio in recurrent cerebral infarction group was significantly higher than that in non-recurrent cerebral infarction group(P<0.05).Vascular stenosis score and collateral circulation filling score in recurrent cerebral infarction group were lower than those in non-recurrent cerebral infarction group(P<0.05).The recurrence of cerebral infarction was correlated with CD4+/CD8+T lymphocyte ratio,vascu-lar stenosis score and collateral circulation filling score(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of CD4+/CD8+T lymphocyte ratio,vascular stenosis score,and collateral circulation filling score to predict recurrent cerebral infarction was 0.975,0.889,and 0.935,respectively,and the AUC of recurrent cerebral infarction was 0.994 when combined with the three factors.The AUC of cerebral infarction recurrence was significantly higher than that of each index alone.Conclusion Serum CD4+/CD8+T lympho-cyte ratio combined with MRA vascular stenosis score and collateral circulation filling score have high efficacy in the diagnosis of recurrent cerebral infarction,which have predictive value for recurrent cerebral infarction.

Objective To analyze the clinical,laboratory and brain MRI features of patients with neurosyphilis(NS).Methods Eighty-five NS patients admitted to the Department of Neurology in Nanjing Second Hospital from November 2018 to November 2022 were retrospectively analyzed.According to the results of brain MRI,the patients were divided into two groups:normal brain MRI + unilateral lesions group and bilateral lesions group(more severe group).ROC were plotted and the areas under the curves(AUC)were calculated to evaluate the diagnostic value of clinical indicators for severe NS on MRI.Results Compared with normal brain MRI + unilateral lesions group,the mean age(P = 0.000),the rate of male(P = 0.008)and the rate of symptomatic NS(P = 0.006)were significantly higher in bilateral lesions group.Moreover,hypersensitive C-reactive protein(P = 0.028),basophil(P = 0.003),fibrinogen(P = 0.011),CSF tolulized red unheated serum test titer(P = 0.004),CSF protein concentration(P =0.000),CSF adenosine deaminase(P =0.003),and CSF white blood cell count(P =0.049)were significantly increased in patients with NS in bilateral brain lesions group.Multivariate regression analysis suggested that age(OR =1.085,P =0.019)and CSF protein concentration(OR =1.004,P =0.023)were risk factors for NS patients with bilateral brain lesions on MRI.The clinical model was established by age,CSF protein concentration,and basophil,the AUC for predicting NS patients with bilateral brain lesions could reach 0.83(95%CI:0.73-0.91,P＜0.01).Conclusions Clinical,laboratory and brain MRI examination should be integrated during the diagnosis and treatment of NS.Elderly patients and patients with high CSF protein concentration suggest severe disease,and reduction of CSF protein concentration is expected to improve the condition of NS patients.

By organizing and studying on the original works of LI Wenrong， this paper aimed to explore his theories and methods for treating liver diseases. LI Wenrong believes that the liver is easily prone to physiological disturbances， difficult to pacify， and can be compared to a “chariot” that moves horizontally and vertically， acting as a “general” for both civil and military affairs. Pathologically， liver diseases tend to spread to other organs， resulting in ever-changing pathological changes， often affecting emotional health. In terms of therapeutic methods， LI Wenrong proposes ten methods including draining fire to calm the liver， nourishing water to moisten wood， clearing metal to calm the liver， calming gallbladder and harmonizing liver， subduing yang with shell-drug， treating liver diseases by supplementing spleen， soothing the liver with sweetness， astringing the liver with sourness， relieving the liver with spiciness， and draining the liver with excess-fire. These methods have great guidance and reference value for contemporary clinical practice in traditional Chinese medicine.