Epilepsy treatment gap and its associated factors in individuals aged 65 years and older with active convulsive epilepsy in rural Northwestern China.

PURPOSE: We investigated the epilepsy treatment gap (ETG) and its associated factors in individuals aged≥65 years with active convulsive epilepsy(ACE) in rural Northwestern China.

METHOD: Between 2008 and 2021, We recruited individuals with ACE in rural Northwestern China as part of an epilepsy management project launched by the Chinese government. A team of primary care doctors from 423 township hospitals participated in the project. Each local primary health organization screens patients from the local community through well-trained local physicians within a study period. Questionnaire-based interviews were conducted to identify patients with ACE, with information collected during the survey. ETG in individuals aged≥65 years with ACE were calculated in the study from 2012 to 2021, and logistic regression analysis was employed to analyze associated factors of ETG in individuals aged≥65 years with ACE in rural northwestern China.

RESULTS

A total of 480 individuals aged≥65 years with ACE (male, 62.7 %) were included. Of these, 176 did not receive appropriate treatment, resulting in an ETG of 36.7 %; Among individuals with an onset age of <65 years, a significantly larger proportion did not receive appropriate treatment compared to those who did receive appropriate treatment(69.9 % vs. 60.9 %, p = 0.047); Univariate analysis indicated that an onset age of <65 years, epilepsy duration of≥20 years, and higher seizure frequency of 12∼23 times within 1 year before inclusion may be associated with ETG in individuals aged≥65 years with ACE (p < 0.05); In multivariate analysis, higher seizure frequency of 12∼23 times within 1 year before inclusion (OR = 1.733,95 % CI 1.031-2.940, p = 0.042) were significantly associated with ETG in individuals aged≥65 years with ACE.

CONCLUSION

Northwestern China rural areas has relatively smaller ETG in the elderly with ACE,at about 36.7 %. However, efforts to prevent and treat ACE in the elderly with a younger onset age (<65 years) and higher seizure frequency (12-23 times within 1 year before inclusion) should be intensified to further narrow the ETG.