Rozpowszechnienie epilepsji, luka w leczeniu i czynniki związane z epilepsją: wyniki z badania neuro-epidemiologicznego Ningxia (NNES) w północno-zachodniej Chinach
Prevalence, treatment gap and factors associated with epilepsy: findings from the Ningxia neuro-epidemiologic study (NNES) in northwestern China
W skrócie
Badacze zbadali ponad 55 tysięcy ludzi w regionie Ningxia i znaleźli, że epilepsja dotyka około 3 na 1000 osób. Okazało się, że ponad jedną trzecią pacjentów z epilepsją nie leczy się lekami przeciwpadaczkowymi, co stanowi poważny problem w opieki medycznej. Najczęściej występuje forma epilepsji z napadami toniko-klonicznymi, a ludność pochodzenia Hui ma wyższe ryzyko epilepsji niż ludność Han.
Oryginalny abstract (angielski)
BACKGROUND AND OBJECTIVES: Prior estimates of epilepsy prevalence in Ningxia have varied substantially across studies, largely reflecting methodological heterogeneity in survey scope, case definitions, and diagnostic criteria. This population-based study used a standardized protocol to estimate the prevalence, treatment gap, seizure characteristics, and factors associated with epilepsy in Ningxia. METHODS: A two-stage cluster random sampling design was applied across 11 surveillance sites in Ningxia Hui Autonomous Region. Trained personnel from the local Center for Disease Control and Prevention (CDC) and primary care institutions conducted door-to-door screening with a 15-item questionnaire. All screen-positive individuals were referred for neurological evaluation by certified epileptologists using the 2014 ILAE clinical definition of epilepsy, with seizure types classified according to the 2017 ILAE framework. Treatment gap was defined as the proportion of active epilepsy cases who had not received any antiepileptic drug (AED) during the one week preceding the survey. RESULTS: Of 55,102 participants (median age 37.7 years, 49.8% male; 66.9% Han and 32.5% Hui; 47.1% rural and 52.9% urban), 181 had active epilepsy. The crude prevalence was 3.28/1000 (age-adjusted 3.34/1000). Prevalence did not differ significantly between rural (crude 3.59/1000; adjusted 3.68/1000) and urban areas (crude 3.02/1000; adjusted 3.06/1000), or between sexes. The Hui population had a significantly higher age-adjusted prevalence than the Han population (4.00/1000 vs. 2.90/1000, p=0.031). Among the 181 patients, 157 (86.7%) reported ever using AEDs and 117 (64.6%) were on AED therapy during the one week preceding the survey, corresponding to a treatment gap of 35.4%. Generalized tonic-clonic seizures were the most common type (64.6%, 117/181). DISCUSSION: In this large population-based survey, epilepsy prevalence in Ningxia was lower than in most previous reports from the region, corresponding to approximately 24,000 people with active epilepsy province-wide. More than one-third of patients with active epilepsy were not receiving AEDs in the week preceding the survey, indicating a substantial treatment gap that warrants further attention in health service planning.