世界卫生组织-全球抗癫痫运动中国农村癫痫示范项目结束后四年随访结果

目的了解全球抗癫癎运动中国农村抗癫癎示范项目终止后4年曾接受苯巴比妥治疗的癫癎患者的远期治疗效果及转归,以为我国农村癫癎患者的防治和管理提供参考依据。方法 2008年7-12月由经过培训的乡卫生院医师采用问卷与访谈相结合的形式入户调查,对原示范项目6省(市)共8个县经苯巴比妥治疗管理的2455例惊厥型癫癎患者进行随访。结果接受苯巴比妥治疗的2455例患者中共随访到1780例,其中939例(52.75%)继续服药,无发作和发作减少超过50%(有效)的患者于项目终止后的12、24、36和48个月时所占比例分别为66.77%(627/939)、68.37%(642/939)、71.35%(670/939)和73.06%(686/939);841例(47.25%)停药患者中244例(29.01%)无发作、320例(38.05%)仍然发作但已停药、277例(32.94%)改用其他类型抗癫癎药物。对939例继续服用苯巴比妥与841例停药的癫癎患者进行疗效比较,继续服药者的远期疗效优于停药者(χ~2=12.423,P=0.002)。停药原因分别为发作停止(244例,29.01%)、改用其他抗癫癎药物(277例,32.94%)、未提供免费药物或无钱买药(93例,11.06%)、治疗效果欠佳(92例,10.94%)、当地买不到苯巴比妥(54例,6.42%)等。至2008年随访结束时共有206例患者死亡,标化死亡比达19.10;其中意外事故死亡为59例(28.64%),其次为脑血管病30例(14.56%)、癫癎持续状态窒息死亡28例(13.59%)。结论 "全球抗癫癎运动"中国农村癫癎示范项目开展成功,远期治疗效果良好,值得进一步推广。癫癎人群死亡率高,尤其是意外事故死亡率高,值得引起注意。     

WHO/IEM/ILAE全球抗癫痫运动-宁夏农村癫痫的流行病学调查

目的：调查宁夏农村癫痫病人的患病率、发病率和治疗缺口。方法：利用统一的调查表，采用随机整群抽样的方法．对宁夏吴忠市利通区杨马湖乡逐家逐户进行癫痫流行病学问卷调查。结果：共调查11630人，确诊癫痫病人99人，癫痫病患病率8．51‰，发病率25．8／100000人。从未接受治疗的病人数45人，占45．5％，不正规治疗的病人数22人，占22．2％，正规治疗的病人数32人，占32．3％，1周内接受过西药治疗的人数19人，占19.2％。结论：宁夏农村地区癫痫病患病率较高，治疗缺口较大。     

我国五省农村地区开展人群干预后癫(癎)治疗缺口的变化

目的 检验我国农村地区开展人群干预管理后癫癎治疗缺口的变化，为进一步推广癫癎社区控制经验提供依据。方法 2004年WHO合作项目结束后6个月，在开展项目的5个省农村示范地区，采用与基线调查完全相同的方法和标准随机抽样调查该地区癫癎流行病学状况，并对两次调查结果进行比较，以了解示范区干预前后癫癎患者的治疗情况以及治疗缺口的改变。结果 本次抽样调查5个农村人群共确诊癫癎患者320例，患病率为0．62％。其中活动性癫癎的患病率为0．45％。而基线调查时癫癎患病率和活动性癫癎的患病率分别为0．70％和0．46％。采用正规治疗的癫癎患者由2000年调查时的24．8％上升至39．1％。活动性癫癎的治疗缺口由基线调查时的62．6％下降为49．8％。结论 农村地区的癫癎患者经过WHO示范项目的干预和管理，接受正规或合理治疗的比例明显提高；活动性癫癎的治疗缺口显著下降。从而证明本方案采用的干预对策适用于我国农村地区，并有很好的推广价值。     

Epilepsy Care in the World: results of an ILAE/IBE/WHO Global Campaign Against Epilepsy survey

PURPOSE: Information about existing resources available within the countries to tackle the huge medical, social, and economic burden caused by epilepsy is lacking. To fill this information gap, a survey of country resources available for epilepsy care was conducted within the framework of the ILAE/IBE/WHO Global Campaign Against Epilepsy. METHODS: The study represents a major collaborative effort involving the World Health Organization (WHO), the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). RESULTS: Data were collected from 160 countries representing 97.5% of the world population. The information included availability, role, and involvement of professional and patient associations for epilepsy, epilepsy treatment and services including antiepileptic drugs, human resources involved in epilepsy care, teaching in epileptology, disability benefits, and problems encountered by people with epilepsy and health professionals involved in epilepsy care. The data confirm that epilepsy care is grossly inadequate compared with the needs in most countries. In addition, large inequities exist across regions and income groups of countries, with low-income countries having extremely meager resources. Complete results of this survey can be found in the Atlas: Epilepsy Care in the World. CONCLUSIONS: The data reinforce the need for urgent, substantial, and systematic action to enhance resources for epilepsy care, especially in low-income countries.     

Long‐term outcome of phenobarbital treatment for epilepsy in rural China: A prospective cohort study

Purpose: To evaluate the long‐term outcome of phenobarbital treatment for convulsive epilepsy in rural China, and to explore factors associated with overall seizure outcomes. Methods: We carried out follow‐up assessments of people who took part in an epilepsy community management program conducted in rural counties of six provinces in China. People with convulsive epilepsy who were previously untreated (or on irregular treatment) were commenced on regular treatment with phenobarbital. Information was collected using a standardized questionnaire by face‐to‐face interviews of the individuals (and their families where necessary). Information collected included treatment status, medication change, seizure frequency, and mortality. Key Findings: Among the 2,455 people who participated in the original program, outcomes were successfully ascertained during the follow‐up assessment in 1986. Among them, 206 had died. Information on treatment response was obtained in 1,780 (56% male; mean age 33.9 years, range 3–84; mean duration of follow‐up 6.4 years). Among them, 939 (53%) were still taking phenobarbital. The most common reasons for stopping phenobarbital were seizure freedom or substantial seizure reduction, socioeconomic reasons, and personal preference. Four hundred fifty‐three individuals (25%) became seizure‐free for at least 1 year while taking phenobarbital, 88% of whom did so at daily doses of 120 mg or below. Four hundred six (23%) reported adverse events, which led to withdrawal of phenobarbital in <1%. The most common adverse effects were malaise/somnolence (7.4%), dizziness (3%), and lethargy (2.6%). At the follow‐up assessment, 688 (39%) individuals had been seizure free for at least the previous year. People with persistent seizures had significantly longer duration of epilepsy and higher number of seizures in the 12 months before treatment. People who were taking AED treatment irregularly at recruitment were less likely to become seizure‐free. Significance: We observed long‐term benefits of regular treatment with phenobarbital for convulsive epilepsy in rural China. One hundred years after the discovery of its antiepileptic effect, phenobarbital is still playing an important role in the management of epilepsy.     

Natural history and mortality of chronic epilepsy in an untreated population of rural Bolivia: A follow-up after 10 years

Purpose:   To evaluate the natural history and mortality of chronic epilepsy in an untreated prevalence cohort of people with epilepsy (PWE) in a rural area of Bolivia.
Methods:   During 1994–1996 we carried out an epidemiologic survey in a sample of 9,995 subjects in the Cordillera province. At the end of the survey we identified 130 PWE, of whom 118 were classified as having "active epilepsy." We revisited this cohort 10 years after the prevalence survey.
Results:   We were able to trace 103 (87.3%) of the 118 PWE previously identified. Ten of the 103 subjects died during the follow-up period. Of the 93 PWE still alive, adequate information on the occurrence of seizures was available for 71 subjects, of whom 31 (43.7%) were seizure-free for more than 5 years; only 3 of these 31 subjects have taken an antiepileptic drug (AED) for more than 1 year. Generalized seizures were associated with a better prognosis. Mortality rate in our prevalent cohort was 10.0/1,000 person-year at risk [95% confidence interval (CI) 5.5–18.3], without a significant increased risk respect to the general population [standardized mortality rate (SMR) 1.34; 95% CI 0.68–2.39]; a significant increased risk of death was found for patients with remote symptomatic epilepsy (SMR 3.0; 95% CI 1.2–6.3) but not with idiopathic epilepsy. Three of the 10 subjects died of causes possibly related to epilepsy.
Discussion:   Our data suggest that spontaneous remission of epilepsy occurs in a substantial proportion of untreated patients affected by chronic epilepsy; concerning mortality, we found a 3-fold increased mortality in patients with remote symptomatic epilepsy.     

儿童脊髓脊膜膨出合并脊髓栓系综合征术后功能恢复的随访

目的 评估脊髓脊膜膨出合并脊髓栓系综合征(TCS)患儿手术后的治疗效果,来确定影响预后的决定性因素.方法 收集2003 - 2007年郑州市儿童医院收治153例脊髓脊膜膨出合并TCS患儿的临床数据,男62例,女91例.通过手术前后症状、体征的改善情况以及辅助检查(如:CT、MRI、泌尿系彩超、尿动力学检查等),对患儿术后恢复情况进行综合评估.结果 (1)大小便改善:术前便秘37例,术后便秘18例;术前大便失禁27例,术后大便失禁13例;术前尿潴留23例,术后尿潴留5例;术前尿失禁34例,术后尿失禁7例;(2)足部畸形及下肢轻瘫:术前101例,术后3年随访77例患儿术后足部畸形得到明显改善,24例患儿无改善(P=0.01);(3)膀胱功能恢复情况:28例术前神经源性膀胱患儿,术后20例膀胱顺应性和最大膀胱压测定容量明显改善(P＜0.05).5例单侧肾脏集合系统分离患儿术后半年及1-3年随访,肾脏集合系统分离明显改善.结论 脊髓病变的严重程度、手术是否完全得到松解以及早期手术、术后长期功能锻炼都是影响预后的重要因素,而是否早期手术对预后的影响尤为重要.     

对海洛因依赖者康复训练的半年随访

目的 评估康复训练对海洛因依赖者的疗效.方法 对1997年9月至1998年2月在劳教所戒毒的87例吸毒劳教人员进行为期6个月的系统康复训练(康复组),对另91例吸毒劳教人员行单纯劳动教养(劳教组).解教后半年对两组进行随访.采用成瘾行为严重度指数表和成瘾行为个案调查表分别于入组前及随访时进行评定.结果 随访时,康复组的操守率(31%)高于劳教组(16%;x2＝4.20,P<0.05);康复组较劳教组在职业功能[分别为(0.56±0.31)分和(0.77±0.31)分]、海洛因滥用[分别为(0.66±0.44)分和(0.86±0.18)分]、违法犯罪[分别为(0.16±0.17)分和(0.27±0.23)分]、家庭社会关系[分别为(0.28±0.12)分和(0.31±0.10)分]、精神健康[分别为(0.12±0.08)分和(0.14±0.13)分]五个方面有改善(P<0.01,0.05).结论 在劳教基础上合并康复训练的疗效优于单纯劳教,戒毒工作应以社会心理康复、预防复吸为重点.     

775例违法精神障碍患者强制医疗后情况调查

目的：了解违法精神障碍患者强制医疗后在社区的情况,探讨再次实施违法行为的相关影响因素。方法对7家安康医院2001年1月～2010年12月强制医疗后出院的精神障碍患者用自拟问卷进行随访,主要内容包括再次违法情况、人口学特征、疾病情况和社区情况等。其中,未再次违法者为对照组,研究组为再次违法者（简称为重复违法者）。结果605例患者完成随访调查表的填写,其中56例（9．3％）患者出现再次违法行为。两组患者出院后的服药情况、出院后病情、是否有监护人和与家人的关系等差异有统计学意义（P ＜0．05）,对照组患者服药依从性更好、病情稳定、有监护人陪伴、与家人关系更加和睦。多因素分析中,既往住院次数、出院后的病情、出院后服药情况和与家人的关系进入回归方程。结论既往住院次数、出院后的病情、出院后服药情况和与家人的关系是强制医疗后出现重复违法情况的重要影响因素。