Institut National de la Santé et de la Recherche Médicale (INSERM) U1094, Tropical Neuroepidemiology, University of Limoges, School of Medicine, Institute of Tropical Neurology, Centre Hospitalier Universitaire (CHU), Limoges, France.
PLoS One. 2012;7(8):e44469. doi: 10.1371/journal.pone.0044469. Epub 2012 Aug 31.
To evaluate the RARE (Réseau Action-Recherche sur l'Epilepsie) program, a model of managing and treating people with epilepsy (PWE) at a primary health-care level in rural areas of Mali, we assessed treatment efficacy and compliance of patients who underwent the first year follow-up.
A network of rural general practitioners (GPs) settled in six rural districts of the regions of Koulikoro, Segou and Sikasso, was involved in the diagnosis, evaluation and monitoring of all the identified PWE and in the distribution of phenobarbital (PB). All the participants were included in a prospective database and followed-up by GPs at 4 months intervals during the first year. Seizure frequency, treatment doses and appearance of adverse events (AEs) were systematically recorded. Efficacy was evaluated in terms of reduction of seizures frequency while noncompliance in terms of time to study withdrawal for any cause.
596 patients treated with PB were included in the analysis. Of these, 74.0% completed the first year follow-up. At the final visit, 59.6% were seizure-free: 31.0% for 12 months, 10.2% for 8 months and 18.4% for 4 months. Adults and patients with convulsive seizures were the most drug-resistant (p<0.002). Few AEs were recorded. The multivariate analysis showed that being a woman, presenting convulsive seizures, having more than 5 seizures/month and had never be treated were predictors of withdrawal (p ≤ 0.05) at 12 months.
This study showed a good response and compliance to the treatment and allowed the identification of some factors associated with failure of management in a setting very near to clinical practice. Awareness campaigns are needed to assure a broader accessibility to treatment and to improve the compliance and continuity with treatment programs.
为了评估 RARE（癫痫研究与行动网络）项目，该项目是在马里农村地区初级卫生保健层面管理和治疗癫痫患者（PWE）的模式，我们评估了接受第一年随访的患者的治疗效果和依从性。
一个由居住在库利科罗、塞古和锡卡索地区六个农村地区的农村全科医生（GP）组成的网络，参与了所有确诊的 PWE 的诊断、评估和监测，以及苯巴比妥（PB）的分发。所有参与者都被纳入一个前瞻性数据库，并由 GP 在第一年每隔四个月进行随访。系统记录了发作频率、治疗剂量和不良反应（AE）的出现情况。疗效评估以发作频率降低为指标，而不依从性则以任何原因退出研究的时间为指标。
共纳入 596 例接受 PB 治疗的患者进行分析。其中，74.0%完成了第一年的随访。在最后一次就诊时，59.6%的患者无发作：31.0%持续 12 个月，10.2%持续 8 个月，18.4%持续 4 个月。成人和有惊厥性发作的患者耐药性最高（p<0.002）。记录到的 AE 很少。多变量分析显示，女性、有惊厥性发作、每月发作超过 5 次、从未治疗过是 12 个月时停药的预测因素（p ≤ 0.05）。
这项研究显示了对治疗的良好反应和依从性，并确定了一些与实践中非常接近的环境下管理失败相关的因素。需要开展宣传活动，以确保更广泛地获得治疗，并提高治疗方案的依从性和连续性。
