ObjectiveTo systematically evaluate the efficacy of steroids combined with antiepileptic drugs compared with alone antiepileptic drugs in the treatment of children with epileptic electrical status during sleep to provide evidence-based medical basis for its treatment.MethodsElectronic searches were maded in PubMed, Embase database, Cochrane Library, CNKI, Wanfang and the Chinese biomedical literature database for the literature about steroids combined with antiepileptic drugs compared with alone antiepileptic drugs in the treatment, and retrieval time is from January 1990 to October 2020. Two evaluators independently screened literature, extracted data, evaluated literature quality and risk of bias and checked each other. Meta analysis was performed by stata16.0 software.ResultsA total of 679 children with ESES were included in 10 studies, including 9 randomized controlled trials and 1 retrospective cohort study. Meta analysis results showed that there were statistically significant differences in clinical improvement rate [RR=1.31, 95%CI (1.21, 1.42), P<0.01], electroencephalogram discharge improvement rate [RR=1.35, 95%CI (1.25, 1.46), P<0.01] and cognitive intelligence score [SMD=1.19, 95%CI (0.80, 1.57), P<0.01] between steroids combined with antiepileptic drugs group and alone antiepileptic drugs group after 6 months follow-up. The incidence of adverse reactions in steroids combined with antiepileptic drugs group was higher than that in alone antiepileptic drugs group, and the difference was statistically significant [RR=4.13, 95%CI (1.06, 16.13), P<0.01]. All adverse reactions improved or disappeared after drug withdrawal.ConclusionCompared with alone antiepileptic drugs, steroids combined with antiepileptic drugs group has advantages in controlling epileptic seizures, improving electroencephalogram abnormalities and improving cognitive ability, and it is relatively safe.
PurposeTo analyze the effect of medication withdraw (MW) on long-term electroencephalogram (EEG) monitoring in children who need preoperative assessment for refractory epilepsy.MethodsRetrospective analysis was performed on the data of preoperative long-term EEG monitoring of children with refractory epilepsy who needed preoperative evaluation in the Pediatric Epilepsy Center of Peking University First Hospital from August 2018 to December 2019. Monitoring duration: at least three habitual seizures were detected, or the monitoring duration were as long as 10 days. MW protocol was according to the established plan.ResultsA total of 576 children (median age 4.4 years) required presurgical ictal EEGs, and 75 (75/576, 13.0%) needed MW for ictal EEGs. Among the 75 cases, 38 were male and 37 were female. The age range was from 15 months to 17 years (median age: 7.0 years). EEG and clinical data of with 65 children who strictly obey the MW protocol were analyzed. The total monitoring duration range was from 44.1 h (about 2 days) to 241.8 h (about 10 days)(median: 118.9 h (about 5 days)). Interictal EEG features before MW were including focal interictal epileptiform discharge (IED) in 39 cases (39/65, 60%), focal and generalized IED in 2 cases (2/65, 3.1%), multifocal IED in 20 cases (20/65, 30.7%), multifocal and generalized IED in 2 cases (2/65, 3.1%), and no IED in 2 cases (2/65, 3.1%). After MW, 18 cases (18/65, 27.7%) had no change in IED and the other 47 cases had changes of IED after MW. And IEDs in 46 cases (46/65, 70.8%) were aggravated, and IED was decreased in 1 case. The pattern of aggravated IED was original IED increasement, in 41 cases (41/46, 89.1%), and 5 cases (5 /46, 10.9%) had generalized IED which was not detected before MW. Of the 46 patients with IED exacerbations, 87.3% appeared within 3 days after MW. Habitual seizures were detected in 56 cases (86.2%, 56/65) after MW, and within 3 days of MW in 80.4% cases. Eight patients (14.3%) had secondary bilateral-tonic seizure (BTCS), of which only 1 patient had no BTCS in his habitual seizures. In 56 cases, 94.6% (53/56) had seizures after MW of two kinds of AEDs.Conclusions① In this group, thirteen percent children with intractable epilepsy needed MW to obtain ictal EEG; ② Most of them (86.2%) could obtain ictal EEG by MW. The IED and ictal EEG after MW were still helpful for localization of epileptogenic zone; ③ Most of the patients can obtain ictal EEG within 3 days after MW or after MW of two kinds of AEDs;4. The new secondary generalization was extremely rare.
ObjectiveTo observe the children with idiopathic epilepsy who received AED therapy and seizure-free, withdrawal at least 1 year, and analyze the risk factors of seizure recurrence. In order to give better instructions for AED withdrawal of children with idiopathic epilepsy in pediatric department. MethodsChildren with idiopathic epilepsy who were seizure-free and had stopped AED treatment at least 1 year before the deadline of observation were collected from pediatric outpatient and inpatient department of the First Affiliated Hospital of Guangxi Medical University from January 2011 to January 2014. The following variables, derived from the case records were analyzed: sex, age at seizure onset, type of seizure, time period between the onset of the first seizure and start of treatment, number of seizures in the time period between the start of AED therapy and the last seizure, number of AEDs before remission, time period between the start of AED therapy and the last seizure, time period between the last seizure and withdrawal of AED treatment (seizure-free period, timing of AED withdrawal), time period between the start of AED withdrawal and total discontinuation(speed of withdrawal), EEG registered at the time of diagnosis, before AED withdrawal, during and after AED withdrawal, and the condition of recurrence, data analysed by multi-variate step-wise Cox regression model analysis. ResultsA total of 16(12.8%) children relapsed in a total number of 125 children with idiopathic epilepsy we collected; date evaluated by multi-variable analysis showed that the children suffering from seizure type of focal seizure, starting withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording was associated with a higher risk of seizure recurrence. ConclusionsChildren with idiopathic epilepsy have a low risk of recurrence after AED withdrawal. Those who suffer from seizure type of focal seizure, start withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording are associated with a higher risk of seizure recurrence.