Objective:The models currently available for predicting the risk of seizure recurrence after antiepileptic drug (AED) withdrawal in adult epilepsy patients include the prediction model developed by Lamberink et al (Lamberink model, 2017) and the Medical Research Council prediction model (MRC model, 1993). However, there was no external validation for the two models. The purpose of this study was to perform an independent external validation and a comparison of the Lamberink model and the MRC model in adult patients. Methods: The study population was recruited from the Wenzhou Epilepsy Follow-up Registry Database (WEFURD). All the predictors of the Lamberink and MRC models and the occurrence of seizure recurrence in the participants were collected based on the WEFURD. Participants' predicted probabilities of seizure recurrence were obtained by a Web-based tool and the prognostic index formula. The external validation of the Lamberink model and the MRC model were quantified by discrimination, calibration, and decision curve analysis (DCA). Results: Of 212 patients, 126 (59.4%) had seizure recurrence after AED withdrawal. The Lamberink 2-year model, the Lamberink 5-year model, the MRC 1-year model, and the MRC 2-year model had areas under the curve of 0.71 (95% confidence interval [CI] = 0.64-0.78), 0.68 (95% CI = 0.60-0.76), 0.60 (95% CI = 0.50-0.69), and 0.58 (95% CI = 0.50-0.66), respectively. Additionally, the Lamberink 2-year model had a significantly better integrated discrimination improvement than the MRC 2-year model (P < .001). Regarding calibration, the Lamberink 2-year model (P = .121) and the MRC 1-year model (P = .264) were well calibrated, but the Lamberink 5-year model (P = .022) and the MRC 2-year model (P = .008) were not. In the DCA, the Lamberink 2-year model performed well at threshold probabilities of 30%-65%. Significance: This external validation shows that the Lamberink 2-year model might be more accurate and has greater clinical benefit than others for guiding drug withdrawal in adult epilepsy clinics. 116 | LIN et aL. K E Y W O R D S adult epilepsy, drug withdrawal, external validation, prediction model, seizure recurrence Key Points • The Lamberink 2-year model had the highest AUC (0.71) among the models in the external validation • The Lamberink 2-year model (P = .121) and the MRC 1-year model (P = .264) were well calibrated, but the other prediction models were not • In the DCA, the Lamberink 2-year model performed well at threshold probabilities of 30%-65%

An epidemiological survey on Tourette syndrome (TS) in a developing country is relatively scarce. This study was conducted to investigate the prevalence and distribution of TS in children and juveniles aged 7-16 years in Wenzhou of P.R. China. A total of 9742 children and adolescents were included in this survey. Cross-sectional study with stratified-cluster sampling method was used. The prevalence of TS among school-age children was estimated to be an average of 0.43%. The ratio of male to female was 10.6 to 1 (0.74% for males and 0.07% for females). Pupils in the age range of 7-16 years are more likely to have comorbid disorders. The mean age at onset of TS was 7.7+/-2.7 years, with 45.2% of them at the age of 6-7. The rate of delayed diagnosis, misdiagnosis and misclassification of the syndrome were 78.6, 42.9 and 23.8%, respectively. This survey supports that TS is a common disease prevalent amongst children and juveniles in Wenzhou area of P.R. China, and its incidence was correlated with age and sex and often misdiagnosed and misclassified.

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Whether leukoaraiosis burden retards short-term recovery after minor stroke is unclear. We investigated the association between leukoaraiosis and early recovery of neurological function after a first minor ischemic stroke in 217 acute stroke patients (National Institutes of Health Stroke Scale (NIHSS) score ≤5). Leukoaraiosis severity was graded according to the Fazekas scale and categorized into none to mild (0–2; n = 143) or severe (3–6; n = 74) groups. NIHSS and Minimum Mental State Examination (MMSE) were assessed at baseline and at 30 days. Univariate analysis revealed that the severe leukoaraiosis group was older in age (P < 0.001) and had fewer low MMSE patients than non-mild group at baseline (39.1% vs 55.9%, P = 0.003). However, the MMSE improved in none to mild group but not in the severe group at 30-day (15.4% vs 36.5%, P < 0.001). At 30-day, the severe leukoaraiosis group had higher NIHSS scores than the none-mild group (P = 0.04). Multiple linear regression analyses demonstrated that leukoaraiosis severity and admission NIHSS were independently associated with the NIHSS score on day 30 (P = 0.034, 95% CI 0.004–0.091 and P = 0.001, 95% CI 0.011–0.04). Binary regression analyses showed that leukoaraiosis severity and admission MMSE were significantly associated with MMSE (dichotomized) at 30-day (OR 2.1, P < 0.01, 95% CI 1.7–2.6 and OR 5.1, P < 0.01, 95% CI 2.1–12.8). Leukoaraiosis burden is an independent predictor of worse short-term functional and cognitive recovery after a minor ischemic stroke.