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PURPOSE: We evaluated the efficacy and tolerability of the ketogenic diet (KD) on generalised convulsions and status epilepticus (SE) in patients with Dravet syndrome (DS). METHODS: Patients with DS having ≥2 generalised convulsions/month despite drug treatment were included in this study and placed on a KD for 6 months. From 3 months before (baseline) to 6 months after KD initiation, caregivers recorded patients' seizure activity, antiepileptic drug use, and adverse events. The KD efficacy was determined by examining the frequency and duration of seizures at 3 and 6 months vs. baseline. Responders were defined as individuals whose generalised convulsions decreased in frequency by ≥50% vs. baseline. Seizures lasting ≥5 min and SE were specifically evaluated. Patients' cognition was also assessed at 3 and 6 months via questionnaire. RESULTS: Twenty patients continued the KD for at least 3 months. Of the 17 responders identified at month 3, seizures decreased by 50-89% and 90-99% in nine and two patients, respectively; six patients were seizure free. The KD was ineffective in three patients, who discontinued the diet. By month 6, seizures decreased by 50-89% and 90-99% in six and one patient(s), respectively; 10 patients were seizure free. The frequency of other seizure types also improved. During all 6 months, neither generalised convulsions lasting ≥5 min nor SE was detected in the 17 responders. The KD also improved patients' cognition. CONCLUSION: The KD is a good treatment option for medically intractable epilepsy.

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<p><b>OBJECTIVE</b>To investigate different treatment methods for stage-Is testicular mixed germ cell tumors (TMGCTs).</p><p><b>METHODS</b>We retrospectively analyzed the clinical data about 3'cases of stage-Is TMGCTs (aged 26-39 years) treated in the 175th Hospital of PLA, reviewed relevant literature, and explored the clinical characteristics of TMGCTs.</p><p><b>RESULTS</b>Of the 3 patients, 1 was treated by radical orchiectomy, 1 by radical orchiectomy + retroperitoneal lymph node dissection + BEP chemotherapy scheme, and the other by radical orchiectomy + radiotherapy. The pathological components of TMGCTs were immature teratoma, seminoma, spermatocytoma, chorioepithelioma, embryonal carcinoma, and yolk sac tumor. No recurrence or distant metastasis was found during the 24-month follow-up after surgery.</p><p><b>CONCLUSION</b>The diagnosis of TMGCTs primarily depends on physical examination, ultrasonography, MRI, and measurement of serum tumor markers, while its confirmation necessitates pathological examination, and its treatment is basically radical orchiectomy.</p>

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<p><b>OBJECTIVE</b>To explore the prevalence and characteristics of chronic headache in children and adolescents in Shanghai and to collect messages concerning the impact and compliance of medication for migraine.</p><p><b>METHODS</b>A population-based questionnaire study was conducted among subjects 6 - 15 years of age sampled from primary and junior high schools in Shanghai and the subjects were followed up.</p><p><b>RESULTS</b>(1) The prevalence: 8701 (88.6%) out of 9857 pupils responded to the questionnaire; 17% of the respondents had headache and in 86.4% of them the reason of headache was unknown. The prevalence of chronic headache in Shanghai children and adolescents was 7.8%, there was no significant difference between both genders (chi(2) = 0.010, P > 0.05). (2) The prevalence of chronic headache increased with age, the incidence was higher in boys before 12 years of age, while higher in girls after 12 years of age. (3) Characteristics of chronic headache: the proportion of unilateral, bilateral and headache of unknown site was similar; in most of the cases headache was localized in the temple (35.2%) and forehead region (25.6%), the duration of headache was short, always accompanied by gastrointestinal symptoms. Half of the patients reported that the headache had affected their study and daily life. (4) The status of using health care facilities: 24% of the students sought medical assistance during their headache episodes and among them only 30.9% took medicine. (5) Over-fatigue (51.4%), followed by insufficient sleep (40.4%), emotional changes (38.5%) were the main aggravating factors. The headache was also associated with positive family history and stress in studying.</p><p><b>CONCLUSIONS</b>Headache is a common complaints of children, affecting the patients' study and daily life. But many patients with headache were not treated properly, therefore, the medical and educational sectors and the society should pay more attention to this problem.</p>

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Objective To explore the clinical characteristics and diagnostic criteria of migraine in children.Methods The migraine cli-nical characteristics of patients that consistent with the chronic headache diagnostic criteria, excluding other diseases,were analyzed.ICHD-Ⅱ childhood migraine diagnostic criteria was used as gold standard to explore the migraine diagnostic criteria in children.Results 1.In 346 patients, 157 fitted ICHD-Ⅱchildhood migraine diagnostic criteria.2.Type of migraine: probable migraine was the most common(68.8%), the most commonly unfulfilled criterion was associated gastroenteritis symptoms; migraine without aura was the second (19.7%).3.The migraine diagnostic criteria: the most important single-variable was headache associated symptoms,with sensitivity of 70.7%,specificity of 83.6%,the positive predictive value(PPV) was 78.2%,positive likelihood ratio (PLR) was 4.31 and area under curve(AUC) was 0.771.The most important three-variables was headache duration of 1-72 hours, moderate-severe headache and headache associated symptoms, with the sensitivity of 52.2%,specificity of 96.2%,the PPV was 90.1%, the PLR was 13.7 and the AUC was 0. 657.Conclusions The most important single-variable is headache associated symptoms,the most important three-variables are headache duration 1-72 hours, moderate-severe headache and headache associated symptoms.

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Objective To comparison of the quality of life in children with migraine and quality of life in children with primary epilepsy(EP)or Tourette's syndrome(TS).Methods There were 239 children with moderate migraine,the time of which lasted from 6 to 36(12.14?4.67)months,headache index 4-20(9.98?3.74).There were 250 cases and 424 cases with EP or TS,respectively,both team members were under good control with single drug therapy,the diagnosed according to the international classification of headache disorders-Ⅱ.The pediatric quality of life inventory,version 4.0,age 8-12 years,and child report forms were used to evaluate the quality of life in children with migraine and the other two kinds of samples by Bonferroni and Mann-Whitney tests.Results The scores of quality of life in children with moderate migraine were lower than those in children with EP(total score 69.06?10.48 vs 81.26?13.80;physical function scores 67.43?14.37 vs 83.14?14.70;psychological function scores 69.92?10.56 vs 80.26?14.32;emotional function scores 66.76?14.09 vs 80.90?18.93;social function scores 76.81?14.67 vs 83.36?17.40;school function scores 66.20?13.62 vs 76.52?13.80).The scores of quality of life in children with moderate migraine were lower than those in children with TS(total scores 69.06?10.48 vs 79.18?11.45;physical function scores 67.43?14.37 vs 81.52?12.61;psychological function scores 69.92?10.56 vs 77.90?12.28;emotional function scores 66.76?14.69 vs 74.07?16.34;social function scores 76.81?14.07 vs 89.06?16.23;school function scores 66.20?13.62 vs 70.35?16.96).Two sets of data between children with moderate migraine and those with EP,TS showed statistical significance(Pa