| ObjectiveEpilepsy is both common disease and frequently-occurring disease in the world and its long-tem seizure make patients’ living quality worsen, make patients’ morbidity for body and mental disease go up, make health-care costs and the financial burden for families and societies increase. At present, There are a number of epilepsy patients and treatment gap. The public commonly discriminate against epilepsy patients, meanwhile, People with epilepsy and their family members know little about the nature and treatment methods for epilepsy or the dos and don’ts on life. Medical workers in three-level health care network are short of scientific cognition and diagnoses and treatment methods. Therefore, patients spend much time and money seeking help for the doctors, but patients’ condition were not under control.The thesis would achieve the following objectives:1. To explore the curative effects and adverse reaction and influencing factors of phenobarbital in the treatment of generalized tonic clonic seizure (GTCS) cases in Shandong Province.2. To gather experience and widely spread the treatment methods for phenobarbital3. To further study the feasibility of manage and treatment for convulsive epilepsy by a short-term train for primary health workers.Methods Patients with convulsive epilepsy in the three county of Shandong province were randomly identified as the study subjects by using stratified and cluster sampling approach. Local primary health workers, who were provided with special training, carried out screening, treatment, and follow-up. During the intervention, a form for doctor and a form for patients will be filled in as source material. Then we analyze these data again. Results1. The baseline data of sample1.1Basic information of the patients804patients with convulsive epilepsy in three counties were found conformed to the standards. There were434men and370women in the group. The average diagnostic age of the patient was (39.07±16.17), the median was38years old. The age of onset was (18.36±14.44). Most patients age distributed in15years old. The frequency of attacks was (19.65±39.25) in the lasted one years and the median was10.1.2Medical institutions where the patients used to goThe medical institutions where the epileptic patients were made a definite diagnosis were individual clinics, county hospitals, township hospitals, municipal hospitals in the three counties in the past. The most patients were diagnosed in the county hospitals, accounting for54.10%of the total cases. Secondly, municipal hospitals accounted for50.50%. Township hospitals and individual clinics had31.72%and24.75%patients respectively. The same patients can be diagnosed in different medical institutions.1.3Diagnostic and therapeutic methods used by the patientsThe instruments used to be diagnosed were electroencephalogram (66.45%), CT (13.37%), nuclear magnetic resonance (0.26%), nevertheless,19.92%patients did not do any examinations. Western medicine, including Phenytoin sodium (42.29%), phenobarbital(27.45%), carbamazepine (22.26%), valproic acid sodium (1.19%), were the main treatment methods in the past. It accounted for81.34%among all the methods. In detail, The daily dose of phenytoin sodium was (309.03±177.74)mg and most patients daily dose concentrated in the300mg. Phenobarbital daily dose was (114.74±103.12)mg, and the median dose was90mg. The daily dose of carbamazepine was (313.37±158.66) mg and most concentrated in the300mg. Valproic acid sodium daily dose was (512.16±239.00) mg, and the median dose was600mg. In addition, other treatment like Chinese medicine, acupuncture, Gezhi, buried line and folk prescription accounted Diagnostic and therapeutic methods used by the patients for18.66%among all the methods.1.4Whether or not to take medicine regularlyRecently, some epileptic patients in three counties did not take medicine regularly, and others patients had never taken any medicine or even received any treatment. The patients, who took medicine irregularly and did not receive any treatment, accounted for83.21%. Then, the patients who did not take medicine regularly accounted for84.11%and the patients who did not received any treatment accounted for15.89%in all the428patients in A county.80patients did not have medicine regularly in C county, accounting for58.39%.57patients had never received medicine therapy accounting for41.61%. At this kind of conditions, most epilepsy attack focused on2times a month and10times a year. On average, only one month the patients did not have epilepsy attack and the rest of the month the patients had the trouble of epilepsy.2. patients’follow-up2.1curative observation After the patients from three counties attaining the phenobarbital maintenance dosage for12months, the obvious effects rate was65.82%, effective rate was11.77%, invalid rate was10.76%and the deterioration rate accounted for11.65%, which the result was assessed by seizures frequency. There are many obvious differences in efficacy among three counties by testing nonparametric one-way ANOVA, which the obvious effects rate in B county is79.04%and65.81%in A county,43.28%C in county. The average maintenance doses for patients were76.30±35.50mg and the median was60mg. Particularly, the median in A county is60mg and in B county is120mg. Another important outcome was the subjective feeling of patients. The patients felt better in44.86%, no change in52.38%and worse in2.76%. Especially the highest rates of feeling better is77.87%, which the patients were from B county. However, the patients feeling no change was87.14%in C county and58.39%in A county.2.2the analysis of adverse reactions The ADR in Phenobarbital is light according to a synthesis of this study, nearly no heavy bad reaction, only1.50%in patients was moderate bad reaction and16.15%was mild. The most patients (82.35%) feel no adverse reactions. Especially, in A county, B county and C county, there were71.87%,99.15%and85.82%in patients feeling no adverse reactions. About the mild adverse reactions, most was sleepy or drowsiness, differently in A county was16.55%, B county was0.43%and C county was10.64%. Others were mild adverse reactions like headache, ataxia, gastrointestinal symptoms, depression, anxiety, hyperactivity and rash as severity ranking.2.3patient compliance Local heath workers assessed patient compliance according to the comparison of the remaining number of tablets is expected and actual number of remaining tablets. The result was good in95.37%and not good in4.63%.3. The analysis of influencing factors of efficacy According to the follow-up form for doctor and the screening form for convulsive epilepsy patients, we found the possible influencing factors and assign them. Then, the data analysts used univariate and multivariate logistic regression analyses for them. In univariate logistic analyses(α=0.05), Statistically significant variables are Q13(Seizures were incontinent or not), Q2(doses of phenobarbital), QC4(change to generalized seizures), Q7(patient compliance judged by local health workers), Q72(The actual remaining number of tablets) However, in multivariate logistic regression analyses, using stepwise regression, the height, seizure type, treatment history and compliance were the influencing factors of efficacy. Especially, the treatment history is the most significant risk factor (OR=8.399), the second is height (OR=1.018), the third is seizure type (OR=0.691) and the compliance is the last (OR=0.409). Through further observation, found that patients with generalized tonic-clonic type, without the experience of treatment, good compliance had good efficacy.Conclusions1. Phenobarbital has a good curative effects and mild adverse reactions for Patients with convulsive epilepsy. Its treatment methods can be widely introduced in Shandong province and also in the other area with the type of convulsive epilepsy.2. The influencing factors, which phenobarbital treated convulsive epilepsy, were patients" height, epileptic seizure type, ever be treated in the past and patients’ compliance.3. By a short-termed training, primary health workers can take on missions, follow-ups and treatments. |
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