| Objectives: Understand the present situation of convulsive epilepsy in rural areas of Jilin province,and the effect of PB and VPA.Analyzed the implementation of the project management in our province rural areas.Provide a theoretical basis for the sustainable development of ?Chinese rural epilepsy management project ",and promote the management and regulation of patients with epilepsy in economically underdeveloped areas.Through the analysis of data in recent years in order to reduce the number of patients with epilepsy,improve the quality of life of patients,reduce the economic burden and mental burden of patients with epilepsy and family,and put forward to a set of practical solutions.Methods: Data collected from 7 counties of Jilin province in the epilepsy management program from January 1,2011 to December 31,2016,then analysis them.By trained doctors in township hospital to screen the patients whose have been identified or suspected of convulsive epilepsy,and fill in the table,then make diagnostic assessment to decide whether included in the therapy group by a neurologist who in charge of the project,whose followed and registered by township hospital doctor,the final entry data.Analysis of the demographic characteristics of epilepsy,treatment gap of active epilepsy,the efficacy of Phenobarbital,Valproate efficacy,the demographic characteristics of patients with death and the data of the retreated patients in the group.Descriptive methods were used to give an overall impression of the baseline characteristics including the gender,age,onset age,disease duration,seizure frequency,et al.when necessary,unpaired t test,chi-square test,Mann–Whitney U test,Kruskal-Wallis test,and Fisher exact test were applied tocompare different variables.Epidata software was used to input the data,and the data were analyzed by SPSS software(16.0).P<0.05 was found to be statistically significant,and P < 0.01 was considered remarkable statistically significant.Results: Total 3655(male 2067)patients with ACE were collected,Male to female ratio is 1.3.Among them,2058 cases were treated with Phenobarbital,and 306 cases were treated with Valproate.The average starting age is 23.73±17.00,and there was no significant difference between male and female(male = 23.99±17.30,female = 23.38±16.11,P=0.279).Mean duration of disease is 17.91±13.96,and female have longer duration than male(male is 17.16±13.91,female is18.88±13.97,P<0.001).There were 1380 cases of active epilepsy in all patients(the seizure frequency more than 2 times every year),and the treatment gap is 56%.There have correlation between efficacy and compliance at the twelfth months for followed up of Phenobarbital group(P=0.032).The patients were followed up over 60 months have 350 cases in Phenobarbital treatment group,the total effective rate of the first,third and fifth years is respectively 64%,84.86% and 96.57%,the difference among them are statistically significant(c2=276.808,P<0.001).At the fifth years of followed up,the average onset age of seizure free,significantly effective,effective,invalid and deteriorate(the same below)respectively is 17.00,15.00,16.00,13.00 and 21.00 years old,and statistical analysis showed there is no significant correlation between the curative effect and the onset age(P=0.207,Kruskal-Wallis test).And the average duration of disease respectively are 25.00,24.50,35.00,29.00 and 26.50 years,there is no significant correlation between the curative effect and the duration of disease(P=0.660,Kruskal-Wallis test).The average of PB dose respectively is 90mg/d,120mg/d,120mg/d,90mg/d and 120mg/d.The patients had ever received formal treatment in 194 cases,received irregular treatment in 137 cases,never treated in 19 cases,and never treated have good curative effect(P=0.047,Fisher exact test).And among them had 29 cases received combination therapy,the analysis result showed there no significant correlation(P=0.545,Fisher exact test).There are 347 patients have good compliance,and There have correlation between efficacy and compliance(P=0.002,Fisher exact test).The patients were followed up over 12 months have 165 cases in Valproate treatment group,and the total effective rate of the third,sixth,ninth and twelfth months is respectively 74.5%,76.4% and 81.4%.There were 129(male 87)deaths during follow-up.The Survival analysis showed that men are more likely to die than women(Men are more likely to die than women).Among them,had ever received formal treatment in 194 cases,received irregular treatment in 137 cases,never treated in 19 cases,and the patients had ever received treatment more likely to die than those had never received treatment(c2=8.114,P=0.017).Among them,121 cases with generalized tonic-clonic seizures(GTCs),1 case with absence seizure,1 cases with simple partial seizure,3 cases with other types of generalized seizures and 3 cases seizure type unknown,the survival analysis showed that the patients with GTCs have more risky of death than others(P<0.001,Fisher exact test).The average onset age of survival patients is 23.66±16.73 years old,and death patients is 34.68±21.84 years old,and the analysis result showed that the greater the age of onset,the greater the risk of death(t=-5.663,P<0.001).The baseline seizure frequency of survival patients is 2.15±11.70 times every year,and death patients is3.86±15.85 times every year,the analysis result showed that there is no significant correlation between the risky and baseline seizure frequency.During following up,there were 465 cases withdraw from our program,and the main reason are refuse treatment and move out,respectively proportion of them are 31.8% and 20.4%.Conclusions: 1.In rural areas of Jilin,men had higher rates of epilepsy,and the rate of treatment gap was reduced from 62.7% to 56% by universal adoption of the program.2.With the prolongation of treatment time,phenobarbital and valproate total efficiency rate increased gradually;Phenobarbital was effective in patients who had never been treated before,and the efficacy of phenobarbital correlated with patient compliance,but was not significantly associated with age of onset,course of disease,number of baseline episodes,and whether or not they were co administered.3.The patients' risk of death,whose with convulsive epilepsy in rural area of Jilin province,was 8.3 times with the total population in Jilin Province,the main causes of death are cardiovasculardiseases and cerebrovascular diseases;in addition,SUDEP accounts for 6.2% of all cases.Men,with generalized tonic clonic seizures,who had received formal antiepileptic treatment,older onset had higher risk of death. |
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