Berlowitz Dan R, Pugh Mary Jo V
Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center, Bedford, Massachusetts 01730, USA.
Int Rev Neurobiol. 2007;81:153-63. doi: 10.1016/S0074-7742(06)81009-3.
This study used the national inpatient, outpatient, and pharmacy databases from the US Veterans Health Administration to examine prescribing patterns for older patients with epilepsy and to determine the factors associated with receiving recommended antiepileptic drugs (AEDs) such as lamotrigine, gabapentin, or carbamazepine. Among patients with epilepsy, the AED monotherapy most prescribed was phenytoin (70%), followed by phenobarbital (17%). While the rate of phenytoin use was similar for both previously and newly diagnosed patients with epilepsy, phenobarbital was less commonly used in newly diagnosed patients. Multivariable analyses suggested that receiving outpatient neurological care was the strongest predictor of receipt of recommended AED regimens in newly diagnosed elderly patients with epilepsy. These data suggest that the challenge remains to narrow the gap between expert recommendations and actual practice if patients with epilepsy are to fully benefit from the tremendous progress that has been made in the pharmacological management of this disease.
本研究利用美国退伍军人健康管理局的全国住院、门诊和药房数据库，调查老年癫痫患者的用药模式，并确定与接受推荐抗癫痫药物（AEDs）如拉莫三嗪、加巴喷丁或卡马西平相关的因素。在癫痫患者中，最常开具的AED单药治疗是苯妥英（70%），其次是苯巴比妥（17%）。虽然癫痫既往诊断患者和新诊断患者的苯妥英使用率相似，但新诊断患者中苯巴比妥的使用较少。多变量分析表明，在新诊断的老年癫痫患者中，接受门诊神经科护理是接受推荐AED治疗方案的最强预测因素。这些数据表明，如果癫痫患者要充分受益于该疾病药物治疗方面取得的巨大进展，缩小专家建议与实际治疗之间的差距仍然是一项挑战。
