Objective：To evaluate the efficacy of phenobarbital monotherapy on epilepsy in rural areas of Jiangsu Province. Methods：The convulsive epilepsy cases were treated with phenobarbital drugs and follow - up management from January 2005 to December 2020. The clinical characteristics，dosage，curative efficacy，and adverse reactions of epilepsy patients were evaluated. Results：A total of 4 315 patients with convulsive seizures were included，and 73.8% of the patients had a maximum phenobarbital dosage ranging from 30 to 90 mg/d. 2 715 patients were followed up for four years，and the effective rate of treatment was 75.44%，with approximately 20% of patients experiencing deterioration of epilepsy symptoms. The incidence of adverse reactions such as fatigue， dizziness，and headache decreased from 16.2%（1st month）to 10.87%（4th year）. Conclusion：The phenobarbital monotherapy for convulsive epilepsy patients achieved good clinical efficacy，and can be further promoted and implemented in rural areas.