Efficacy assessment of phenobarbital in epilepsy: a large community-based intervention trial in rural China.

BACKGROUND: Many people with epilepsy need not experience further seizures if the diagnosis and treatment are correct. Most epilepsy patients have convulsions, which are usually fairly easy to diagnose. This study tested a model for treatment of people with convulsive forms of epilepsy at primary health-care level in rural areas of China. METHODS: Patients with convulsive epilepsy were identified at primary care level and provided with phenobarbital monotherapy. Local physicians, who were provided with special training, carried out screening, treatment, and follow-up. A local neurologist confirmed the diagnoses. Efficacy was assessed from the percentage reduction in seizure frequency from baseline and the retention of patients on treatment. FINDINGS: The study enrolled 2455 patients. In 68% of patients who completed 12 months' treatment, seizure frequency was decreased by at least 50%, and a third of patients were seizure free. 72% of patients who completed 24 months' treatment had reduction of seizure frequency of at least 50% and a quarter of patients remained seizure free. Probability of retention was 0.84 at 1 year, and 0.76 at 2 years. Medication was well tolerated and reported adverse events were mild; only 32 patients (1%) discontinued medication because of side-effects. INTERPRETATION: This pragmatic study confirmed that this simple protocol was suitable for the treatment of convulsive forms of epilepsy in rural areas of China. Physicians with basic training could treat epilepsy patients with phenobarbital, with beneficial effects for most patients with convulsive seizures. Few cognitive or behavioural adverse events were noted, but formal psychometric testing was not done.

Interaction between oppositely charged micelles or globular proteins.

Monte Carlo simulations and the hypernetted chain theory are used to study the interaction between spherical macroions of opposite charge immersed in a solution of monovalent or divalent simple electrolyte. These calculations represent the first step toward studying phase behavior and precipitation kinetics in solutions containing a mixture of macroions with positive and negative net charges. The potential of mean force between colloidal particles is determined as a function of colloid-colloid separation. In addition to having an opposite sign, the calculated potential of mean force is found to be stronger and longer-ranged than observed in the case of equally charged macroparticles. The difference is more pronounced in the presence of divalent counterions and is especially noticeable when we compare distinct Coulombic and hard-core collision contributions to the interaction between equally and oppositely charged colloids. The present observations suggest the dominance of attractive forces between globally neutral but electrostatically heterogeneous macroparticles. While our numerical results cannot be successfully analyzed by existing theories, they provide useful guidance and benchmark data for the development of advanced analytic descriptions.