Prevalence Of Antiepileptic Drugs Use Research Articles

Anti-Epileptic Drugs in Geriatric Neurosurgery: A Review of 669 Neurosurgical Cases

Background and PurposePatients over the age of 75 are more likely to develop epilepsy than children under the age of 10. Patients of all ages are prescribed anti-epileptic drugs; however, those over the age of 65 are the most typically prescribed group.MethodsThis is a retrospective study of geriatric cases admitted to the Neurosurgery Department in Khoula Hospital from January 1, 2016 to December 31, 2019. A medical records of 669 patients were identified. Patients’ demographics, risk factors, usage of anti-epileptic drug (AED), type of tumor, tumor location, neuro-vital signs diagnosis, Glasgow coma scale on arrival, treatment types, and length of stay (LOS) were recorded.ResultsThe prevalence of AEDs use was 19%. Patients with traumatic brain injury (TBI) were found to have a higher rate of using AEDs (32.1%) followed by patients with oncological and vascular pathologies, respectively (30.1% and 21.6%). There was a significant relationship between the utilization of AEDs among different neurological diseases investigated (p<0.05). Patients who received surgical interventions were using AEDs much more than patients with conservative management (p=0.001). There was a significant difference in the LOS and the usage of AEDs. Added to that, the results signify a relationship between the intensive care unit (ICU) admission and the utilization of AEDs in which the majority of the patients who were not on AEDs were not admitted to the ICU (p<0.05). Phenytoin was the most commonly used AED among different neurosurgical pathologies in the present study (n=110).ConclusionsAEDs are used as prophylaxis to prevent seizures before most neurosurgical procedures and were commonly prescribed in TBI patients. Phenytoin was found to be the commonest AEDs utilized among the different neurosurgical categories followed by levetiracetam.

Pemantauan Kadar Obat Antiepilepsi secara Farmakokinetika Terhadap Clinical Outcome pada Pasien Pediatrik

The high prevalence of antiepileptic drug use in pediatrics increases the risk of side and toxic effects; therefore, it is necessary to monitor drug levels. Therapeutic drug monitoring is conducted through pharmacokinetics by calculating blood drug levels based on respondents' dose and frequency of therapy. This study aimed to determine the pharmacokinetics of antiepileptic drug levels and the correlation with clinical outcomes using descriptive observational design. Furthermore, the Indonesian Epilepsy Community collected respondents' data from June to July 2020 through online and telephone interviews. Out of the 11 respondents that recieved phenytoin, only 1 (9.09%) was in the therapeutic range (10–20 mg/L), while 10 (90.91%) were outside the therapeutic range (&lt;10mg/L). From the 14 respondents that received phenobarbital, 8 (57.14%) were in the therapeutic range (15–40 mg/L), and 6 (42.86%) were outside the therapeutic range (&lt;15 mg/L and &gt;40 mg/L). From the 47 respondents that received valproic acid, 23 were administered through monotherapy, 7 (30.44%) were in the therapeutic range (50–100 mg/L), and 16 (69.56%) were outside the therapeutic range (&lt;50 mg/L and &gt;100mg/L). Out of the 24 respondents that received valproic acid as monotherapy, 18 (75%) were in the therapeutic range (50–100 mg/L), and 6 (25%) were outside the therapeutic range (&lt;50 mg/L and &gt;100mg/L). The results showed that there was no significant relationship (p&gt;0.05) between drug levels and clinical outcome in respondents treated with either monotherapy or polytherapy of valproic acid. In conclusion, a total of 38 respondents (52.05%) had drugs levels outside the therapeutic range, while 35 (47.95%) had drug levels in the therapeutic range. Furthermore, respondents with drug levels outside the therapeutic range require direct monitoring of antiepileptic drug levels to avoid toxic effects and improve clinical outcomes.

Prevalence trends and individual patterns of antiepileptic drug use in pregnancy 2006-2016: A study in the five Nordic countries, United States, and Australia.

To describe recent international trends in antiepileptic drug (AED) use during pregnancy and individual patterns of use including discontinuation and switching. We studied pregnancies from 2006 to 2016 within linked population-based registers for births and dispensed prescription drugs from Denmark, Finland, Iceland, Norway, Sweden, and New South Wales, Australia and claims data for public and private insurance enrollees in the United States. We examined the prevalence of AED use: the proportion of pregnancies with ≥1 prescription filled from 3 months before pregnancy until birth, and individual patterns of use by trimester. Prevalence of AED use in almost five million pregnancies was 15.3 per 1000 (n = 75 249) and varied from 6.4 in Sweden to 34.5 per 1000 in the publicly-insured US population. AED use increased in all countries in 2006-2012 ranging from an increase of 22% in Australia to 104% in Sweden, and continued to rise or stabilized in the countries in which more recent data were available. Lamotrigine, clonazepam, and valproate were the most commonly used AEDs in the Nordic countries, United States, and Australia, respectively. Among AED users, 31% only filled a prescription in the 3 months before pregnancy. Most filled a prescription in the first trimester (59%) but few filled prescriptions in every trimester (22%). Use of AEDs in pregnancy rose from 2006 to 2016. Trends and patterns of use of valproate and lamotrigine reflected the safety data available during this period. Many women discontinued AEDs during pregnancy while some switched to another AED.

The Prevalence and Factors Associated with Antiepileptic Drug Use in US Nursing Home Residents.

Antiepileptic drugs (AEDs) are commonly used by nursing home residents, both on- and off-label. The landscape of AED use has changed over the past two decades; however, despite this, contemporaneous research on AED use in US nursing home residents is scant. The aim of this study was to estimate the prevalence of AED use, describe prescribing patterns, identify factors associated with AED use, and assess whether these factors differ among AEDs with expanded indications in older adults (i.e. gabapentin, pregabalin, topiramate, and lamotrigine). We conducted a cross-sectional study among 549,240 long-stay older residents who enrolled in fee-for-service Medicare and lived in 15,111 US nursing homes on 1 September 2016. Demographics and conditions associated with AED indications, epilepsy comorbidities, and safety data came from the Minimum Data Set Version 3.0 (MDS 3.0). Medicare Part D claims were used to identify AED use. Robust Poisson models and multinomial logistic models for clustered data estimated adjusted prevalence ratios (aPR), adjusted odds ratios (aOR), and 95% confidence intervals (CIs). Overall, 24.0% used AEDs (gabapentin [13.3%], levetiracetam [4.7%], phenytoin [1.9%], pregabalin [1.8%], and lamotrigine [1.2%]). AED use was associated with epilepsy (aPR 3.73, 95% CI 3.69-3.77), bipolar disorder (aPR 1.20, 95% CI 1.18-1.22), pain (aPRmoderate/severe vs. no pain 1.42, 95% CI 1.40-1.44), diabetes (aPR 1.27, 95% CI 1.26-1.28), anxiety (aPR 1.12, 95% CI 1.11-1.13), depression (aPR 1.17, 95% CI 1.15-1.18), or stroke (aPR 1.08, 95% CI 1.06-1.09). Residents with advancing age (aPR85+ vs. 65-74years 0.73, 95% CI 0.73-0.74), Alzheimer's disease/dementia (aPR 0.87, 95% CI 0.86-0.88), or cognitive impairment (aPRsevere vs. no impairment 0.62, 95% CI 0.61-0.63) had decreased AED use. Gabapentinoid use was highly associated with pain (aORmoderate/severe vs. no pain 2.07, 95% CI 2.01-2.12) and diabetes (aOR 1.79, 95% CI 1.76-1.82), but not with an epilepsy indication. AED use was common in nursing homes, with gabapentin most commonly used (presumably for pain). That multiple comorbidities were associated with AED use underscores the need for future studies to investigate the safety and effectiveness of AED use in nursing home residents.

Antiepileptic use for epilepsy and nonepilepsy disorders: A population-based study (1998-2013).

To examine the trends in antiepileptic drug (AED) use among individuals living in Manitoba with and without a history of epilepsy. Using data obtained from administrative health databases in Manitoba, we assessed the quarterly prevalence of AED use between 1998 and 2013 among individuals with and without a history of epilepsy using cross-sectional time series analysis. Over the study period, the number of individuals prescribed AEDs increased more than 3-fold, from 8,883 to 27,246. The prevalence of AED use among patients with epilepsy increased by 3%, from 789.6 per 1,000 in 1998/1999 to 813.9 per 1,000 in 2012/2013 (p < 0.001 after 2006). In contrast, we observed a 210% increase in AED use among patients without epilepsy from 6.8 to 21.1 per 1,000 over the same period (p < 0.001). We observed a 55-fold rise in gabapentin use among patients without a seizure disorder (from 0.2 to 11.1 per 1,000; p < 0.001), while gabapentin use among those with epilepsy increased only 2-fold, from 21.6 to 41.3 per 1,000 (p < 0.001). There has been a marked increase in the prevalence of AED users over the last 15 years, with a large shift towards the use of newer antiepileptic agents (primarily gabapentin) among those without epilepsy. Further research on the effect of these trends on health and economic outcomes will be of interest for clinicians and policymakers.

Antiepileptic drug use in a nursing home setting: a retrospective study in older adults

The authors set out to examine qualitatively the use of antiepileptic drugs (AEDs) in a population of older adults in a nursing home setting, evaluating aspects such as specialist prescriptions and changes in dosage. This retrospective prevalence study was carried out in a state-funded nursing home that provides care and rehabilitation for elderly people. The first objective of the study was to determine the prevalence of AED use in this population. The second objective was to monitor AED dosage modifications during the fifteen-month study period, focusing on the safety and the tolerability of AEDs. In the period of time considered, 129 of 402 monitored patients received at least one anti-epileptic therapy. The prevalence of AED use was therefore 32%. Gabapentin was found to be the most commonly prescribed drug, with a frequency of 29%, and it was used mainly for anxiety disorders, psychosis, neuropathic pain and mood disorders.

Trends in the use of antiepileptic drugs among pregnant women in the US, 2001-2007: a medication exposure in pregnancy risk evaluation program study.

Little is known about the extent of antiepileptic drug (AED) use in pregnancy, particularly for newer agents. Our objective was to assess whether AED use has increased among pregnant women in the US, 2001-2007. We analysed data from the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) database, 1 January 2001 to 31 December 2007. We identified liveborn deliveries among women, aged 15-45 years on delivery date, who were members of MEPREP health plans (n=585615 deliveries). Pregnancy exposure to AEDs, determined through outpatient pharmacy dispensing files. Older AEDs were available for clinical use before 1993; other agents were considered newer AEDs. Information on sociodemographic and medical/reproductive factors was obtained from linked birth certificate files. Maternal diagnoses were identified based on ICD-9 codes. Prevalence of AED use during pregnancy increased between 2001 (15.7 per 1000 deliveries) and 2007 (21.9 per 1000 deliveries), driven primarily by a fivefold increase in the use of newer AEDs. Thirteen per cent of AED-exposed deliveries involved a combination of two or more AEDs. Psychiatric disorders were the most prevalent diagnoses, followed by epileptic and pain disorders, among AED users regardless of AED type, year of conception or gestational period. AED use during pregnancy increased between 2001 and 2007, driven by a fivefold increase in the use of newer AEDs. Nearly one in eight AED-exposed deliveries involved the concomitant use of more than one AED. Additional investigations of the reproductive safety of newer AEDs may be needed.

Trends in the use of antiepileptic drugs in Taiwan from 2003 to 2007: A Population-Based National Health Insurance study

The aim of this study was to evaluate the prevalence of prescription and use of antiepileptic drugs (AEDs) for the treatment of epilepsy and other indications in a nationwide population using a prescription database. AED prescription data were collected from the National Health Insurance Research Database (NHIRD) in Taiwan for a 5-year period (2003-2007). Patients prescribed AEDs at least two times from 2003 to 2007 were selected for the study from a random sample that included approximately 600,000 people. The prevalence of AED use (per 1000 inhabitants) increased from 12.6 in 2003 to 13.8 in 2007. The prevalence of newer AED use increased progressively from 1.0 in 2003 to 3.8 in 2007, but the prevalence of older AED use decreased during this time (11.6-10). Carbamazepine and valproic acid were the most common AEDs used. Among the newer generation of AEDs, gabapentin was the most frequently used. Newer AEDs were used primarily to treat pain disorders. The primary class of drugs used to treat epileptic disorders was older AEDs. An increase in the use of AEDs was observed over a 5-year period in data collected from NHIRD. This might implicate the use of newer compounds at clinical practice not only increased in the treatment of epilepsy, but also in the conditions other than epilepsy especially pain disorders.

Prevalence of treated epilepsy in western medicine among the adult population in Taiwan: A study conducted using antiepileptic drug prescription data

To determine the prevalence of treated epilepsy in the Taiwan in 2004 using prescription data from the National Health Insurance (NHI) research database and to compare this rate with estimates from other prevalence studies. A cohort was extracted from a group of antiepileptic drug (AED) users who met two inclusion criteria: (1) use of AED more than once and International Classification of Disease (ICD) codes indicating epilepsy or (2) use of AEDs except clonazepam for more than 90 days without ICD codes of epilepsy. In total, 559 AED users were included. The estimated crude prevalence of AED use was 0.42% of the adult population (0.4% for women and 0.45% for men), and 72% of the cohort (n=400) used only one AED. Our estimate of prevalence of treated epilepsy through the NHI system has much larger coverage of population with more credible registration system, and appears to be closer to the truth than two previous small-scaled community-based studies in Taiwan.

Outcome in Patients With Subarachnoid Hemorrhage Treated With Antiepileptic Drugs: Rosengart AJ, Dezheng H, Tolentino J, et al. J Neurosurg 2007;107:253–60

This prospective, multi-center study evaluated the prevalence of anti-epileptic drug use (AED) and the impact of AED on in-hospital complications and outcomes in patients with subarachnoid hemorrhage (SAH). The authors examined data collected on 3552 patients with SAH from 162 neurosurgical centers in 21 countries between 1991 and 1997. AEDs were used in 65.1% of patients with SAH, with phenytoin being the most frequently prescribed drug 52.8% of the time. Using conditional logistic regression, the authors found AED treatment varied dramatically according to study country (interclass correlation coefficient of 0.22, 95% confidence interval [CI] 0.20–0.24; p = 0.001) and individual study centers (interclass correlation coefficient of 0.66, 95% CI 0.62–0.70; p < 0.001). Patients treated with AEDs had significantly higher odds of having an unfavorable outcome relative to those without AED use based on Glasgow Outcome Scale score after adjustment for study center, neurological grade, age, and systolic blood pressure on admission (odds ratio [OR] 1.56, 95% CI 1.16–2.10; p = 0.003). The odds ratios of all in-hospital complications were higher in patients treated with AEDs compared to those without AED use, and included cerebral vasospasm (OR 1.87, 95% CI 1.43–2.44; p < 0.001), neurological deterioration (OR 1.61, 95% CI 1.25–2.06; p < 0.001), cerebral infarction (OR 1.33, 95% CI 1.01–1.74; p = 0.04), and elevated temperatures (OR 1.36, 95% CI 1.03–1.80; p = 0.03). The authors conclude that prophylactic AED treatment in patients with SAH is common, follows an arbitrary prescribing pattern based on institution and physician, and may be associated with increased in-hospital complications and possible worse outcome.

Prescribing patterns of antiepileptic drugs in Italy: a nationwide population‐based study in the years 2000–2005

To evaluate prevalence of use and prescribing patterns of antiepileptic drugs (AEDs) in Italian general practice. Primary care data were obtained from the Health Search Database, a longitudinal observational database implemented by the Italian College of General Practitioners (GPs). We selected 465 061 subjects registered by the end of 2005 in the lists of 320 GPs, homogeneously distributed throughout Italy. Prevalence of AED use was assessed in the entire sample and by drug type, age group, year and main geographic area (north, centre and south/islands). Overall, 24 383 subjects (5.2%) received at least one AED prescription in the study period. Prevalence of AED use (with 95% confidence interval) increased progressively from 7.1 (6.9-7.3) in 2000 to 11.8 (11.5-12.1) in 2005 for old AEDs and from 1.1 (1.0-1.2) to 12.2 (11.9-12.5) for new AEDs. Carbamazepine, phenobarbital and valproic acid were the most common AEDs until 2003, when gabapentin became first. There were no differences in prescribing patterns in the three main geographic areas. Newer AEDs were mostly used in patients aged 65 years and older. The more widespread use of newer AEDs was for mood disorders or pain. Older AED currently remain first line drugs for epileptic disorders. An increasing use of AEDs has been recently observed over a 6-year period in Italian general practice, mostly explained by newer compounds used for conditions other than epilepsy.

Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs

Prophylactic use of antiepileptic drugs (AEDs) in patients admitted with aneurysmal subarachnoid hemorrhage (SAH) is common practice; however, the impact of this treatment strategy on in-hospital complications and outcome has not been systematically studied. The goal in this study was twofold: first, to describe the prescribing pattern for AEDs in an international study population; and second, to delineate the impact of AEDs on in-hospital complications and outcome in patients with SAH. The authors examined data collected in 3552 patients with SAH who were entered into four prospective, randomized, double-blind, placebo-controlled trials conducted in 162 neurosurgical centers and 21 countries between 1991 and 1997. The prevalence of AED use was assessed by study country and center. The impact of AEDs on in-hospital complications and outcome was evaluated using conditional logistic regressions comparing treated and untreated patients within the same study center. Antiepileptic drugs were used in 65.1% of patients and the prescribing pattern was mainly dependent on the treating physicians: the prevalence of AED use varied dramatically across study country and center (intraclass correlation coefficients 0.22 and 0.66, respectively [p < 0.001]). Other predictors included younger age, worse neurological grade, and lower systolic blood pressure on admission. After adjustment, patients treated with AEDs had odds ratios of 1.56 (95% confidence interval [CI] 1.16-2.10; p = 0.003) for worse outcome based on the Glasgow Outcome Scale; 1.87 (95% CI 1.43-2.44; p < 0.001) for cerebral vasospasm; 1.61 (95% CI 1.25-2.06; p < 0.001) for neurological deterioration; 1.33 (95% CI 1.01-1.74; p = 0.04) for cerebral infarction; and 1.36 (95% CI 1.03-1.80; p = 0.03) for elevated temperature during hospitalization. Prophylactic AED treatment in patients with aneurysmal SAH is common, follows an arbitrary prescribing pattern, and is associated with increased in-hospital complications and worse outcome.

Antiepileptic drug use and epileptic seizures in elderly nursing home residents: A survey in the province of Pavia, Northern Italy

Some surveys indicate that elderly nursing home residents are extensively prescribed antiepileptic drugs (AEDs). Few studies have evaluated the prevalence of seizure-related diagnoses as a risk factor for AED administration in nursing homes. To assess the prevalence of AED use and of epileptic seizures in the elderly nursing home residents in our country, we considered age and gender data, functional status (measured by the Barthel's Index), drugs currently administered on a scheduled basis, clinical diagnoses from the patient's chart including possible history of epileptic seizures, of all subjects aged 60 years and over living in 21 federated nursing homes in the province of Pavia, Northern Italy. Data relating to 2.001 subjects (77.5 % females) were collected over a 4-month period (September–December 2000). Eighty-seven of the 2.001 residents (4.3%; 5.3% of all the males and 4.0% of all the females) were taking AEDs and 58 (3.5% of all the males and 2.7% of all the females), all of them under treatment with at least one AED, had epileptic seizures in their history. Both these subgroups had a mean modified Barthel's Index score significantly lower than that of the population as a whole. Phenobarbitone was the most frequently prescribed AED, and the penetration of newer AEDs was minimal. Subjects in early old age (60–74 years) were more likely than older subjects to take an AED. Logistic regression indicated a significant association between seizures reports, a younger age and a history of cerebrovascular events, alcohol abuse and meningiomas. The prevalence of AED use in this study was lower than that found by previous U.S. studies: nevertheless, our data confirm male gender and early old age as factors associated with AED taking in elderly nursing home residents. In our series AED users showed a lower level of autonomy. Taken together, our data suggest that an earlier institutionalization of seizure subjects could be facilitated by the clustering of various conditions, such as seizures, cerebrovascular events, other clinical disorders and a possibly inappropriate anticonvulsant treatment.

Factors associated with antiepileptic drug use among elderly nursing home residents.

BACKGROUND. Epilepsy, a chronic condition defined as two or more recurrent, unprovoked seizures, has the highest incidence at the end of life. Antiepileptic drugs (AEDs) are the primary therapeutic mode. Approximately 10%-11% of elderly nursing home residents receive one or more AEDs, a higher prevalence than would be expected in this age group. In the research literature, there is not a clear explanation of variations in AED use in nursing homes. The purpose of this study was to examine the prevalence and variations in use of AEDs by resident characteristics, AEDs used, drug dosage, and AED combinations in treatment regimens. This was a retrospective, cross-sectional study of residents (N = 21,551) in a convenience sample of nursing homes in 24 states and the District of Columbia. The unit of analysis was the individual resident. The study period was a single day in 1995. Bivariate and multivariate analyses were used to test differences. The prevalence of AED use was 10.5% across all elderly residents. In a multivariate analysis, factors associated with AED treatment included seizure indication, age group, and geographic region. AED use by age group showed declining use as the residents aged, from 65-74 to 75-84 to > or =85 years. The inverse relationship between AED use and age group was unexpected because the incidence of epilepsy increases with advancing age. This finding raises important questions about the future use of these drugs in elderly nursing home residents.