Abstract
Data on prescribing patterns of antiepileptic drugs (AEDs) to older adult inpatients are limited. To assess changes in prescribing patterns of AEDs to older adult inpatients with late-onset epilepsy between 2009-2010 and 2015-2019, and to interpret any unexpected patterns over the 2015-2019 period. Patients aged ≥60 years with late-onset epilepsy from a tertiary center were selected. Demographic data, seizure characteristics and etiology, comorbidities, and comedications were analyzed, in addition to prescription regimens of inpatients taking AEDs to treat epilepsy. AED regimens were categorized into two groups: group 1 included appropriate AEDs (carbamazepine, oxcarbazepine, valproic acid, gabapentin, clobazam, lamotrigine, levetiracetam, topiramate, and lacosamide); and group 2 comprised suboptimal AEDs (phenytoin and phenobarbital). Multivariate logistic regression analysis was performed to identify risk factors for prescription of suboptimal AEDs. 134 patients were included in the study (mean age: 77.2±9.6 years). A significant reduction in the prescription of suboptimal AEDs (from 73.3 to 51.5%; p<0.001) was found; however, phenytoin remained the most commonly prescribed AED to older adult inpatients. We also found an increase in the prescription of lamotrigine (from 5.5 to 33.6%) and levetiracetam (from 0 to 29.1%) over time. Convulsive status epilepticus (SE) and acute symptomatic seizures associated with remote and progressive etiologies were risk factors for the prescription of suboptimal AEDs. Phenytoin was the main suboptimal AED prescribed in our population, and convulsive SE and acute symptomatic seizures associated with some etiologies were independent risk factors for phenytoin prescription. These results suggest ongoing commitment to reducing the prescription of suboptimal AEDs, particularly phenytoin in Brazilian emergence rooms.
Highlights
People aged over 60 years represent the fastest-growing population group in the world[1]
Exclusion criteria were: (1) older adult inpatients who had been admitted with a diagnosis of seizure that was not confirmed or who were later diagnosed with other paroxysmal neurological disorders such as syncope, delirium, or transient ischemic attack; (2) patients with isolated acute symptomatic seizures, including those who had seizures in the setting of an acute traumatic brain injury and were followed up by the neurosurgery team, except those with remote and/or progressive seizures who had a seizure due to an acute cause at the time of the study; (3) previously included patients who had been readmitted to the hospital, even if they had had other seizures; and (4) patients on antiepileptic drugs (AEDs) for conditions other than epilepsy such as neuropathic pain, mood disorders, and migraine
Patients who did not have remote or progressive etiologies associated with acute symptomatic seizures were four times more likely to be in the appropriate regimen group than those patients who did [1⁄(e-1.42784)=4.1697] (p=0.02)
Summary
People aged over 60 years represent the fastest-growing population group in the world[1]. Prescription of antiepileptic drugs (AEDs) has been increasing as epilepsy diagnoses in older people escalate. This demographic shift poses important challenges to prescription safety. Methods: Patients aged ≥60 years with late-onset epilepsy from a tertiary center were selected.Demographic data,seizure characteristics and etiology,comorbidities,and comedications were analyzed,in addition to prescription regimens of inpatients taking AEDs to treat epilepsy. Conclusions: Phenytoin was the main suboptimal AED prescribed in our population, and convulsive SE and acute symptomatic seizures associated with some etiologies were independent risk factors for phenytoin prescription These results suggest ongoing commitment to reducing the prescription of suboptimal AEDs, phenytoin in Brazilian emergence rooms
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
