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

Abstract

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.