Abstract
Purpose: To examine the mortality rate and causes of death of phenobarbital (PB) monotherapy and sodium valproate (VPA) monotherapy in patients with convulsive epilepsy in rural northeast China and compare the differences in the results between the two antiepileptic drugs.Methods: Patients with convulsive epilepsy were recruited by trained public health workers in a project for epilepsy prevention and treatment. Patients were enrolled between January 2010 and December 2018 and were treated with PB or VPA. Mortality rate (MR), the proportional mortality ratio (PMR) for each cause, standardized mortality ratio, and years of potential life lost (YPLL) for sex, age, and cause were estimated based on the 2018 Chinese rural population.Results: A total of 3,916 patients with convulsive epilepsy enrolled in the study, of whom 3,418 received PB and 498 received VPA. There were 325 reported deaths (300 from the PB group) during the follow-up period. The MRs were 9.96 and 5.73% in the PB and VPA groups, respectively. The overall SMRs were 12.92 (95% confidence intervals [CI]: 11.50–13.93) and 7.39 (95% CI: 4.78–10.91), for the PB and VPA groups, respectively. Cerebrovascular disease and heart disease were the major causes of death in both treatment groups. The average YPLL for the PB group (21.9 years) was higher than that for the VPA group (13.4 years).Conclusion: This is the first epidemiological study to examine the MR of patients with epilepsy in rural northeast China. Our study is somewhat different from previous studies reported in China, and we provide new relevant data from northeast China.
Highlights
Epilepsy is a common chronic disease of the brain that affects people of all ages
The diagnostic criteria for convulsive epilepsy were as follows: patients who displayed two of the following symptoms that included loss of consciousness, rigidity, or generalized convulsive movements; and at least one of the following symptoms that included urinary incontinence, bitten tongue or an injury sustained in a fall, post-seizure fatigue, or headache or muscle aches after seizure [11]
According to the admission criteria, a total of 3,916 patients with convulsive epilepsy were enrolled in this study between January 2010 and December 2018, of whom 3,418 patients (1947 men) were treated with phenobarbital (PB group) and 498 patients (294 men) were treated with sodium valproate (VPA group)
Summary
Epilepsy is a common chronic disease of the brain that affects people of all ages. There are an estimated 65 million people with epilepsy (PWE) worldwide, with roughly 80% of them living in developing countries [1, 2]. Mortality among PWE in low- and middle-income countries (LMICs) is higher than that in high-income countries [3], and it is estimated to be 2.6-fold higher than in general populations of LMICs [4]. Treatment gap may be one of the reasons contributing to the higher mortality rate (MR). The causes of the epilepsy treatment gap in developing countries have been related to the health systems, mainly regarding inadequate skilled workforce, cost of treatment, and unavailability of drugs [5]. Three-quarters of PWE in LMICs do not Epilepsy Mortality in Northeast China receive the treatments they need [6]. Phenobarbital and sodium valproate are two traditional broad-spectrum antiepileptic drugs (AEDs) that are inexpensive, efficacious, and usually taken with good compliance
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