Follow ⁃up study of the WHO ⁃Global Campaign Against Epilepsy Demonstration Project in rural China after four years of its termination

Abstract

Objective To follow up the outcome of 2455 patients with epilepsy (the cohort) treated by phenobarbital (PB) during the WHO⁃Global Campaign Against Epilepsy Demonstration Project (GCAE/DP) in rural China after 4 years of its termination, to provide practical evidence for community control of epilepsy in rural China. Methods In 2008, the trained local township physicians, using a well⁃designed questionnaire, by door⁃to⁃door interview, followed up the cohort residents in 8 counties of 6 provinces where the GCAE/DP was conducted and completed for 4 years. Results One thousand seven hundred and eighty of the 2455 patients were visited in the follow⁃up study. Nine hundred and thirty⁃nine (52.75%) were still taking PB, the effectiveness rates (seizure free and seizure frequency reduced > 50%) among them at 12, 24, 36, 48 months after the GCAE/DP were 66.77% (627/939), 68.37% (642/939), 71.35% (670/939), 73.06% (686/939), respectively. In 841 patients (47.25%) who stopped taking PB, 244 cases (29.01%) were seizure free, 320 (38.05%) still had seizures but discontinued the treatment, 277 (32.94%) were treated by other antiepileptic drugs (AEDs). Chi ⁃ square test was used to compare the therapeutic effectiveness in 939 patients continuing taking PB and 841 patients abandoning PB. Patients continuing taking PB had a better outcome than patients abandoning PB (χ2 = 12.423, P = 0.002). The main reasons of PB withdrawal were seizure free (29.01%), taking other AEDs (32.94%), no free drug or no money (11.06%), effect was not good or PB was not available (6.42% ). Two hundred and six patients died between 2002 and 2008. The standardized mortality ratio (SMR) for the cohort was 19.10. The three leading causes of death were: accidents (n = 59, 28.64% ), cerebrovascular diseases (n = 30, 14.56% ) and status epilepticus (n = 28, 13.59%). Conclusion The GCAE/DP was successful and with long term good results, so it is worthy for further promotion. The mortality rate was very high in the people with epilepsy in this sudy, especially deaths from accidents, which should be noticed.

DOI：10.3969/j.issn.1672⁃6731.2012.05.007