Institut National de la Santé et de la Recherche Médicale UMR 1094, Tropical Neuroepidemiology, Limoges, France ; Univ. Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, Centre national de la recherche scientifique FR 3503 GEIST, Limoges, France ; Centre Hospitalier Universitaire, Limoges, France ; Cambodian Society of Neurology, Phnom Penh, Cambodia.
PLoS One. 2013 Sep 5;8(9):e74817. doi: 10.1371/journal.pone.0074817. eCollection 2013.
We tested two treatment strategies to determine: treatment (a) prognosis (seizure frequency, mortality, suicide, and complications), (b) safety and adherence of treatment, (c) self-reported satisfaction with treatment and self-reported productivity, and policy aspects (a) number of required tablets for universal treatment (NRT), (b) cost of management, (c) manpower-gap and requirements for scaling-up of epilepsy care.
We performed a random-cluster survey (N = 16510) and identified 96 cases (≥1 year of age) in 24 villages. They were screened by using a validated instrument and diagnosed by the neurologists. International guidelines were used for defining and classifying epilepsy. All were given phenobarbital or valproate (cost-free) in two manners patient's door-steps (March 2009-March 2010, primary-treatment-period, PTP) and treatment through health-centers (March 2010-June 2011, treatment-continuation-period, TCP). The emphasis was to start on a minimum dosage and regime, without any polytherapy, according to the age of the recipients. No titration was done. Seizure-frequency was monthly and self-reported.
The number of seizures reduced from 12.6 (pre-treatment) to 1.2 (end of PTP), following which there was an increase to 3.4 (end of TCP). Between start of PTP and end of TCP, >60.0% became and remained seizure-free. During TCP, ∼26.0% went to health centers to collect their treatment. Complications reduced from 12.5% to 4.2% between start and end of PTP and increased to 17.2% between start and end of TCP. Adverse events reduced from 46.8% to 16.6% between start and end of PTP. Nearly 33 million phenobarbital 100 mg tablets are needed in Cambodia.
Epilepsy responded sufficiently well to the conventional treatment, even when taken at a minimal dosage and a simple daily regimen, without any polytherapy. This is yet another confirmation that it is possible to substantially reduce direct burden of epilepsy through means that are currently available to us.
我们测试了两种治疗策略，以确定：（a）治疗方案的预后（发作频率、死亡率、自杀和并发症）；（b）治疗的安全性和依从性；（c）患者对治疗的满意度和自我报告的生产力；以及政策方面的问题：（a）全民治疗所需的片剂数量（NRT）；（b）管理成本；（c）癫痫护理扩大所需的人力差距和要求。
我们进行了一项随机群组调查（N=16510），在 24 个村庄中发现了 96 例（年龄≥1 岁）病例。他们使用经过验证的工具进行了筛选，并由神经科医生进行了诊断。国际指南用于定义和分类癫痫。所有患者都免费接受苯巴比妥或丙戊酸钠治疗（2009 年 3 月至 2010 年 3 月，初级治疗期，PTP）和通过卫生中心治疗（2010 年 3 月至 2011 年 6 月，治疗延续期，TCP）。重点是根据接受者的年龄，以最低剂量和方案开始治疗，避免任何联合治疗。没有进行滴定。每月进行发作频率和自我报告。
发作次数从治疗前的 12.6 次减少到 PTP 结束时的 1.2 次，随后增加到 TCP 结束时的 3.4 次。在 PTP 开始到 TCP 结束期间，超过 60.0%的患者发作次数减少并保持无发作状态。在 TCP 期间，约 26.0%的患者前往卫生中心领取治疗药物。在 PTP 开始到结束期间，并发症从 12.5%减少到 4.2%，而在 PTP 开始到结束期间增加到 17.2%。在 PTP 开始到结束期间，不良事件从 46.8%减少到 16.6%。柬埔寨需要大约 3300 万片 100 毫克苯巴比妥片剂。
即使采用最低剂量和简单的日常方案，且不进行任何联合治疗，常规治疗对癫痫的反应也足够好。这再次证实，通过我们目前拥有的手段，可以大大减轻癫痫的直接负担。
