title: Enhancing medical compliance of patients with convulsive epilepsy in rural community: a randomized intervention trial.
abstract: OBJECTIVE
  This randomized intervention trial was to determine whether the implementation of a practical intervention was effective in enhancing medical compliance and improving seizure control among patients with convulsive epilepsy in rural communities in western China.
  
  
  METHODS
  Two of four areas were randomly selected for this study and assigned to be the intervention group (IG) and the control group (CG), respectively. An intervention package with four components (intensive education, consultation services, maintenance of an epilepsy tracking card, and repeated reminders) was formulated. Medical compliance included antiepileptic drug (AED) adherence and lifestyle; each was graded on a 6-point scale with possible scores. Medical compliance and seizure control were measured and compared between the groups before and after the intervention. In addition, correlation of both changes in medical compliance and seizure frequency were investigated.
  
  
  RESULTS
  After 1-year follow-up, 183 patients in the IG (105 male) and 177 in the CG (99 male) remained for the analysis. At the end of the study, the average number of seizures in the IG declined 18.3% compared to that prior to the intervention (after 6-month phenobarbital monotherapy), nearly twice as much as in CG (9.1%) with statistical difference (p = 0.023). The proportion of patients with a reduction in seizures >50% (including those who were seizure-free) rose to 79.8% in the IG compared to 61.0% in the CG (p < 0.05). With regard to medical compliance, the majority of the IG members were rated as excellent or very good, but medical compliance remained nearly unchanged for the CG. A moderate correlation was found between the changes in AED adherence and seizure control (r = 0.4, p < 0.05), and a weaker correlation was found between lifestyle and seizure control (r = 0.328, p < 0.05).
  
  
  CONCLUSIONS
  This intervention package proved to be efficient in enhancing medical compliance and improving seizure control in rural communities of resource-poor areas.
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.forename: Yang
authors.initials: Y
authors.lastname: Si
authors.forename: Jia
authors.initials: J
authors.lastname: Hu
authors.forename: Ling
authors.initials: L
authors.lastname: Liu
authors.forename: Ying
authors.initials: Y
authors.lastname: Deng
authors.forename: Jun
authors.initials: J
authors.lastname: He
authors.forename: Ning-Mei
authors.initials: NM
authors.lastname: Zhang
authors.forename: Dong
authors.initials: D
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D002681:China; D003187:Compliance / Q000187:drug effects; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: Community; Convulsive epilepsy; Medical compliance