Galimberti Carlo Andrea, Magri Flavia, Magnani Barbara, Arbasino Carla, Cravello Luca, Marchioni Enrico, Tartara Amelia
I.R.C.C.S. C. Mondino Institute of Neurology Foundation, via Mondino 2, 27100 Pavia, Italy.
Epilepsy Res. 2006 Jan;68(1):1-8. doi: 10.1016/j.eplepsyres.2005.09.031. Epub 2005 Dec 5.
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.
一些调查表明，老年疗养院居民被广泛开具抗癫痫药物（AEDs）。很少有研究评估癫痫相关诊断作为疗养院中AED给药风险因素的患病率。为了评估我国老年疗养院居民中AED使用和癫痫发作的患病率，我们考虑了居住在意大利北部帕维亚省21家联合疗养院中所有60岁及以上受试者的年龄和性别数据、功能状态（用巴氏指数衡量）、目前定期服用的药物、患者病历中的临床诊断，包括癫痫发作的可能病史。在4个月期间（2000年9月至12月）收集了2001名受试者的数据（77.5%为女性）。2001名居民中有87人（4.3%；占所有男性的5.3%，所有女性的4.0%）正在服用AEDs，其中58人（占所有男性的3.5%，所有女性的2.7%）有癫痫发作史，他们都在接受至少一种AED治疗。这两个亚组的平均改良巴氏指数得分均显著低于总体人群。苯巴比妥是最常开具的AED，新型AED的渗透率极低。老年早期（60 - 74岁）的受试者比年龄较大的受试者更有可能服用AED。逻辑回归表明癫痫发作报告、较年轻的年龄以及脑血管事件、酗酒和脑膜瘤病史之间存在显著关联。本研究中AED的使用患病率低于美国先前研究的结果：然而，我们的数据证实男性性别和老年早期是老年疗养院居民服用AED的相关因素。在我们的系列研究中，AED使用者的自主水平较低。总体而言，我们的数据表明，癫痫患者、脑血管事件、其他临床疾病以及可能不适当的抗惊厥治疗等多种情况的聚集，可能有助于癫痫患者更早地入住疗养院。
