China has approximately 10 million people with epilepsy. There is a vast epilepsy treatment gap in China, mainly driven by deficiencies in health-care delivery and social discrimination resulting from cultural beliefs about epilepsy. WHO's Global Campaign Against Epilepsy project in China showed that it was possible to treat epilepsy in primary care settings, which was a notable milestone. The China Association Against Epilepsy has been a necessary force to stimulate interest in epilepsy care and research by the medical and scientific community. Nearly 20 different anti-seizure medications are now available in China. Non-pharmacological options are also available, but there are still unmet needs for epilepsy management. The Chinese epilepsy research portfolio is varied, but the areas in which there are the most concentrated focus and expertise are epidemiology and clinical research. The challenges for further improvement in delivering care for people with epilepsy in China are primarily related to public health and reducing inequalities within this vast country.

/pdf/epilepsy-in-china-major-progress-in-the-past-two-decades-2kvr4ijsks.pdf

Epilepsy in China: major progress in the past two decades

Pharmacoresistance - Epidemiology, mechanisms, and impact on epilepsy treatment.

OBJECTIVE After the failure of the first antiepileptic drug (AED) at doses > 50% defined daily dose (DDD), there are three options for patients with epilepsy: combination therapy, alternative therapy, and increased dosage of the first AED. However, present studies have not provided evidence for which option is best. Therefore, we conducted this retrospective observational cohort study to compare the effects of three treatment schedules. METHODS Patients diagnosed with newly diagnosed epilepsy at the epilepsy clinic of West China Hospital between August 2006 and February 2016 were evaluated for eligibility for this study. Patients who failed to respond to the first AED at doses > 50% DDD were included, and divided into three cohorts: increased dosage, combination therapy, and alternative therapy. Cumulative incidence curves for time to seizure freedom were compared for different cohorts by Gray test. Competing risk regression was conducted to evaluate the association of clinical predictors with seizure freedom. RESULTS Altogether, 502 patients (277 male, 55.2%) were included for further analysis, and the median duration of follow-up was 32 months (range = 8-127). The probability of seizure freedom was significantly higher in patients receiving combination therapy (n = 323) compared to the alternative therapy cohort (n = 76, P < 0.001) and increased dosage cohort (n = 103, P = 0.025). Competing risk regression analysis showed that combination therapy significantly increased the probability of seizure freedom (hazard ratio [HR] = 2.423, 95% confidence interval [CI] = 1.529-3.841, P < 0.001). In addition, male sex and generalized seizure were significantly associated with increased probability of seizure freedom (male sex: HR = 1.440, 95% CI = 1.106-1.880, P = 0.007; generalized seizure: HR = 1.543, 95% CI = 1.176-2.020, P = 0.002). SIGNIFICANCE Combination therapy may increase the probability of seizure freedom for patients with first AED failure due to lack of efficacy.

Response to treatment schedules after the first antiepileptic drug failed.

Self-management is crucial for patients with epilepsy (PWE) as it can effectively control the condition, improve treatment outcomes, and reduce the risk of seizures. The objective of this study was to evaluate the effectiveness of health education based on the Information-Motivation-Behavioral Skills (IMB) model in improving self-management, quality of life, and medication adherence among PWE.This study was conducted in a district in Shanghai, China, from September 2022 to March 2023. A total of 90 PWE were randomly assigned to an intervention group or a control group. Patients in the intervention group received health education based on the IMB model, whereas those in the control group received routine medical treatment only. The effectiveness of the intervention was evaluated by measuring self-management ability, quality of life, and medication adherence at three months and six months after the intervention.The study included a total of 90 PWE; among them, 55 patients (61.11%) were male, divided into two groups: 45 participants in the control group and 45 participants in the intervention group. After 3 and 6 months of intervention, the self-management scores of the intervention group were significantly higher than those of the control group (t = 14.274, 12.448; P < 0.05). After 6 months of the intervention, the quality-of-life scores of the intervention group were significantly higher than those of the control group (t = 2.025, P < 0.05), and the medication adherence in the intervention group was significantly higher than that in the control group (X2 = 9.003, P < 0.05).Health education based on the IMB model is a promising approach to improving self-management, quality of life, and medication adherence among PWE. It provides personalized, patient-centered interventions that consider patients' knowledge, motivation, and behavior skills, and could be a useful tool for healthcare providers in developing comprehensive care plans for individuals with epilepsy. 

An information-motivation-behavioral skills model-based intervention for patients with epilepsy

Epilepsy is a chronic disorder of the brain that affects people worldwide The standard treatment of epilepsy is optimal use of antiepileptic drug Efficacy of an antiepileptic drug refers to its effectiveness in preventing or reducing the recurrence of a particular seizure type For example physicians may not use sodium valproate in female patients who are planning to have children because of its teratogenic side effects So clinicians should give emphasis for patients with these characteristics to counsel on how to minimize or prevent adverse effects from antiepileptic drugs or giving reassurance about it if it is minor Pharmacovigilance PV is the monitoring of drugs and the prevention of the risk of adverse effects resulting from their use whether this risk is potential or proven The aim of the PV study to detect and identify the adverse drug reactions ADRs induced by the treatment of antiepileptic drugs in epileptic patients This prospective study was carried out for three months in an out patient department of neurology of a multispeciality teaching hospital nbsp

/pdf/a-pharmacovigilance-study-of-monitoring-focusing-of-adverse-172hfubvpg.pdf

A pharmacovigilance study of monitoring & focusing of adverse drug reactions induced by antiepileptic drugs used in epileptic patients

It has been suggested that uncontrolled epilepsy might not necessarily equate to drug resistance when antiepileptic drugs (AEDs) are used at relatively low doses, a practice frequently observed in rural areas of China. To assess the clinical benefits of further drug manipulation in this situation, we prospectively followed up the outcomes of patients with uncontrolled epilepsy while taking relatively low doses of AEDs. The study included patients aged 16 years and older with uncontrolled epilepsy and who were receiving at least one AED at a dosage below 50% of the World Health Organization (WHO) defined daily dose (DDD) (50% DDD) (Group 1). Patients with drug-resistant epilepsy were included for comparison (Group 2). Both groups were followed-up for at least 2 years. Seizure outcomes after further drug manipulations were recorded at the last follow-up. A total of 197 patients (55.3% male) were included in Group 1 and 32 (46.9% male) in Group 2; their mean duration of follow-up was 28.85 ± 1.90 and 30.91 ± 2.04 months, respectively. At the last follow-up, 16.8% (33/197) of patients in Group 1 had become seizure-free compared with none in Group 2 (p < 0.001). Seventeen of 93 (18.3%) patients in Group 1 became seizure free after increasing the dosage of baseline AED(s) alone. Only 5.5% (3/55) of patients who had failed to respond to an AED at ≥50% DDD at baseline became seizure free compared with 21.1% (30/142) who did not have such a history (p = 0.001). The number of AEDs taken at a dosage below 50% DDD at baseline was not associated with seizure outcome. Uncontrolled epilepsy could become controlled in a substantial proportion of patients by dose increase alone, particularly if there is no history of drug failure at ≥50% DDD.

/pdf/impact-of-drug-manipulation-on-seizure-freedom-in-adults-3qjclifhqa.pdf

Impact of Drug Manipulation on Seizure Freedom in Adults with Uncontrolled Epilepsy: A Prospective Controlled Study in Rural China

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Impact of Drug Manipulation on Seizure Freedom in Adults with Uncontrolled Epilepsy: A Prospective Controlled Study in Rural China