Enhancing medical compliance of patients with convulsive epilepsy in rural community: a randomized intervention trial.

PURPOSE: 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. KEY FINDINGS: 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). SIGNIFICANCE: This intervention package proved to be efficient in enhancing medical compliance and improving seizure control in rural communities of resource-poor areas.

Arterial compliance changes in diabetic normotensive patients after angiotensin-converting enzyme inhibition therapy.

BACKGROUND: Diabetes mellitus (DM) is known to cause increased arterial wall stiffness and increased cardiovascular risk, even in the absence of hypertension. This study was designed to investigate whether use of an angiotensin-converting enzyme (ACE) inhibitor may improve arterial stiffness in normotensive diabetics, using pulse wave velocity (PWV) as a surrogate marker. METHODS: We studied 42 patients (26 with type 2 DM, aged 56.5 +/- 9 years, 16 with type 1 DM, aged 41.5 +/- 11 years) by measuring PWV at baseline (compared to 15 age- and gender-matched normal subjects) and after 6 months of treatment with perindopril (4 mg/d). RESULTS: At baseline, PWV was significantly higher in DM patients versus controls (13.09 +/- 2.59 v 9.5 +/- 1.6 m/sec, respectively, P < .001). After 6 months, PWV decreased significantly to 11.68 +/- 3.08 m/sec (P < .003) for the whole DM group. However, the results were driven by the change in the younger type 1 DM (from 12.59 +/- 1.59 to 10.35 +/- 2.21 m/sec, P < .001), whereas in the type 2 DM it was insignificant (from 13.37 +/- 3.0 to 12.42 +/- 3.28 m/sec). Blood pressure and other hemodynamic and biochemical parameters remained unchanged. CONCLUSIONS: The results demonstrate that ACE inhibition can improve arterial elasticity and hence risk of cardiovascular complications even in normotensive diabetics. This short treatment was effective only in younger patients with type 1 diabetes, suggesting that early initiation of therapy before the onset of advanced structural alterations is likely to be more cardioprotective.