Li Rongxin, Zhao Danyang, Li Nan, Lin Weihong
Department of Neurology, The First Hospital of Jilin University, Changchun, China.
Front Neurol. 2024 Oct 23;15:1429964. doi: 10.3389/fneur.2024.1429964. eCollection 2024.
Effective management of epilepsy in working-age patients is essential to reduce the burden on individuals, families, and communities. This study aimed to assess the long-term efficacy of phenobarbital (PB) in working-age patients with epilepsy in rural Northeast China and identify the risk factors for seizures during treatment.
Patients aged 18-65 years diagnosed with convulsive epilepsy in rural areas of Jilin Province between 2010 and 2024 were included, and demographic and clinical data were recorded. Seizure frequency, self-efficacy, adherence, and adverse events (AEs) were assessed monthly.
Of the 3,568 participants, 288 (8.1%) withdrew from the study and 159 (4.5%) died. During the first year of treatment, 75.2% of patients experienced a ≥50% reduction in seizure frequency compared with baseline (considered as treatment effectiveness); 53.7% of patients were seizure-free. By the tenth year, 97.7% of patients showed treatment effectiveness, and 89.6% were seizure-free. Self-efficacy was improved in 37.8% of patients in the first year and in 72% of patients by the tenth year. The independent risk factors for seizures during treatment were higher baseline seizure frequency [odds ratio (OR) = 1.431, 95% confidence interval (CI): 1.122-1.824], presence of multiple seizure types (OR = 1.367, 95% CI: 1.023-1.826), and poor adherence (OR = 14.806, 95% CI: 3.495-62.725), with significant differences observed in the first, third, and fifth years. The most commonly reported AEs were drowsiness (43.3%), dizziness (25.0%), and headaches (17.0%), most of which were mild and decreased over time. Age at enrollment was the only factor influencing withdrawal (hazard ratio = 0.984, 95% CI: 0.973-0.996, = 0.010), with a substantial number of patients who withdrew (32.6%) relocating for work. Cardiovascular disease was the primary cause of death, and age at enrollment was the only risk factor (hazard ratio = 1.026, 95% CI: 1.009-1.043, = 0.002).
Working-age adults with epilepsy demonstrated a favorable response and tolerability to PB monotherapy. Baseline seizure frequency, seizure type, and adherence consistently predicted prognosis throughout the treatment period. Withdrawal was mainly explained by work-related pressures in this age group. Therefore, it is essential to implement interventions that support patient adherence to therapy and maintain stable regimens.
有效管理育龄期癫痫患者对于减轻个人、家庭和社区的负担至关重要。本研究旨在评估苯巴比妥（PB）对中国东北农村地区育龄期癫痫患者的长期疗效，并确定治疗期间癫痫发作的危险因素。
纳入2010年至2024年间在吉林省农村地区诊断为惊厥性癫痫的18至65岁患者，并记录人口统计学和临床数据。每月评估癫痫发作频率、自我效能感、依从性和不良事件（AE）。
3568名参与者中，288人（8.1%）退出研究，159人（4.5%）死亡。在治疗的第一年，75.2%的患者癫痫发作频率较基线降低≥50%（视为治疗有效）；53.7%的患者无癫痫发作。到第十年，97.7%的患者显示治疗有效，89.6%的患者无癫痫发作。第一年37.8%的患者自我效能感得到改善，到第十年这一比例为72%。治疗期间癫痫发作的独立危险因素为较高的基线癫痫发作频率[比值比（OR）=1.431，95%置信区间（CI）：1.122-1.824]、存在多种发作类型（OR=1.367，95%CI：1.023-1.826）和依从性差（OR=14.806，95%CI：3.495-62.725），在第一、第三和第五年观察到显著差异。最常报告的不良事件为嗜睡（43.3%）、头晕（25.0%）和头痛（17.0%），大多数为轻度且随时间减少。入组年龄是影响退出的唯一因素（风险比=0.984，95%CI：0.973-0.996，P=0.010），大量退出的患者（32.6%）因工作搬迁。心血管疾病是主要死因，入组年龄是唯一的危险因素（风险比=1.026，95%CI：1.009-1.043，P=0.002）。
育龄期癫痫成人对PB单药治疗表现出良好的反应和耐受性。基线癫痫发作频率、发作类型和依从性在整个治疗期间一直是预后的预测因素。该年龄组的退出主要是由工作压力导致的。因此，实施支持患者坚持治疗并维持稳定治疗方案的干预措施至关重要。
