Long-term seizure, comorbidity and socioeconomic outcomes of patients with convulsive epilepsy in rural West China.

PURPOSE: This study aimed to investigate the long-term outcomes of patients with convulsive epilepsy in rural West China and to explore potential related factors. METHODS: Patients who were provided Phenobarbital as a treatment and followed-up monthly were enrolled from the Convulsive Epilepsy Control and Management Program in West China. Their clinical and demographic information were obtained from the program database and a questionnaire. Seizure outcomes, comorbidities, annual income, marital status, employment and quality of life (QOL) were evaluated as long-term outcomes. Logistic regression was used to analyze the related factors. RESULTS: Of 473 eligible patients with a median follow-up time of nearly 7 years, 312 (66 %) had one-year terminal remission. A total of 320 (67.7 %) patients had a low annual income (<5000 Yuan), and 198 (41.9 %) patients reported a comorbidity. Among 460 patients of marriageable age, 137 (29.8 %) were unmarried. 60.4 % (333) patients reported improved QOL. Time of follow-up, seizure frequency during early treatment, compliance, annual cost for epilepsy treatment and annual income were related to the seizure outcome. Baseline seizure frequency was associated with comorbidities. Sex, annual cost for epilepsy treatment and seizure outcomes were associated with annual income. Age, sex and age at onset were correlated with current marital status. Compliance and taking traditional Chinese medicine were associated with QOL. CONCLUSION: The prognosis of epilepsy goes beyond being seizure-free. Comorbidities, income and marriage outcomes in resource-poor areas are less promising. Systematic management considering prognosis-related factors for epilepsy by a collaboration of health providers and society is needed.

Prevalence and risk factors of depression and anxiety among patients with convulsive epilepsy in rural West China.

OBJECTIVES: To explore the prevalence and risk factors of depression and anxiety in patients with convulsive epilepsy (PWE) in rural West China. METHODS: PWE from rural West China were evaluated for depression and anxiety with the Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E; Chinese version) and the Generalized Anxiety Disorder-7 (GAD-7; Chinese version). We also assessed their quality of life using the Quality of Life in Epilepsy Inventory (QOLIE-31) and their level of social support using the Social Support Rating Scale (SSRS). We used logistic regression analysis to identify independent risk factors of depression and anxiety and analysis of variance (ANOVA) to investigate the association between quality of life and depression and anxiety. RESULTS: Of the 458 PWE in our study, 33.4% have anxiety and 52.6% have depression. SSRS (P = 0.03) and seizure frequency (P = 0.007) are independent risk factors of anxiety, and annual income of the patients (P < 0.001) is an independent risk factor of depression. PWE with both depression and anxiety have significantly lower QOLIE-31 total and subtotal scores. CONCLUSIONS: PWE have a high prevalence of depression and anxiety in rural West China, which may be impacting their quality of life. PWE with depression and anxiety got a worse quality of life, and depression had a greater impact on quality of life for PWE than anxiety. The risk factors of depression and anxiety include seizure frequency and social support, while annual income is an additional risk factor of depression. Identifying risk factors early may be helpful in the timely management of these symptoms.

Terminal seizure frequency and its relation to SUDEP.

BACKGROUND: Sudden unexpected death in epilepsy (SUDEP) is a major cause of death in patients with epilepsy. Several risk factors have been implicated, including early age of onset, tonic-clonic seizures and antiepileptic drugs. However, whether patients who die from SUDEP have a greater frequency of seizures in the few months before death is unclear. We investigated the terminal seizure frequency and its relation to SUDEP among a large group of patients with tonic-clonic seizures in rural West China. METHODS: We used the database from the Convulsive Epilepsy Control and Management Program in West China, which routinely provides phenobarbital (PB) as a treatment for convulsive epilepsy. Patients with probable SUDEP were included according to pre-set criteria. A verbal autopsy was undertaken for each case. By matching each patient's age, sex, date of joining the program, time in follow-up, and baseline seizure frequency, we set up a 1:5 ratio control group. SPSS 21.0 statistics were applied to compare the differences in seizure frequency 3months prior to SUDEP between patients with probable SUDEP and controls. Furthermore, the dynamic changes of terminal seizure frequency 6-9months, 3-6months, and 3months prior to SUDEP was also analyzed. RESULTS: A total of 41 patients who died from probable SUDEP were identified out of 7844 patients during 10years of follow-up. The SUDEP group had a significantly higher tonic-clonic seizure frequency 3months before their deaths than the control group (p=0.023). At the same time, their seizure-free rate was lower than the control group (p=0.025). Patients with probable SUDEP who were followed up over 12months were further studied as a subgroup. They had more tonic-clonic seizures 3months prior to death compared to the control group (p=0.010). They also had an increase in seizure frequency in their terminal phase (3months prior) compared to an earlier stage (3-6months prior) (p=0.029). Furthermore, the terminal PB dose in the SUDEP group was higher than the control group (p=0.002). CONCLUSION: Patients who died from SUDEP had more frequent tonic-clonic seizures 3months before their deaths. Higher seizure frequency increases the exposure to peri-ictal pathophysiological events, which possibly relate to SUDEP. This phenomenon may be due to the drug resistance potential of these patients or the high dose of PB. Further research is required to ascertain the underlying mechanisms of SUDEP.