Garrard Judith, Harms Susan L, Eberly Lynn E, Leppik Ilo E
Division of Health Policy and Management, School of Public Health University of Minnesota, Minneapolis, Minnesota 55455, USA.
Int Rev Neurobiol. 2007;81:165-82. doi: 10.1016/S0074-7742(06)81010-X.
The University of Minnesota Epilepsy Research and Education Program published two studies evaluating the use of antiepileptic drugs (AEDs) among nursing home (NH) elderly. The studies used a large, nongovernmental data set for studying this population. This chapter is a summary of those two studies. In the first study, a 1-day point prevalence study, 10.5% of the NH residents had one or more AED orders, a prevalence 10 times greater than that found in the community. In a multivariate analysis of factors associated with AED treatment, seizure indication was the most important factor, and age was inversely related to AED use. Phenytoin was the most commonly used AED, followed by carbamazepine, phenobarbital, and valproic acid. The most frequently used combination was phenytoin and phenobarbital. In the second study, evaluating NH admission data, 8% of newly admitted residents were already receiving one or more AEDs when they entered the NH. Factors associated with AED use in this group included epilepsy/seizure disorder, age, cognitive performance, and manic depression (bipolar disease). Among residents recently admitted who were not using an AED at entry, 3% were initiated on an AED within 3 months of admission. Among the factors associated with the initiation of AEDs during this period, the strongest association was with epilepsy/seizure disorder. Manic depression (bipolar disease) was also significantly associated with initiation of an AED after admission. In this group, there was an inverse relationship between age and initiation of an AED.
明尼苏达大学癫痫研究与教育项目发表了两项研究，评估了疗养院（NH）老年人使用抗癫痫药物（AEDs）的情况。这些研究使用了一个大型的非政府数据集来研究这一人群。本章是这两项研究的总结。在第一项研究中，即一项为期1天的现患率研究，10.5%的NH居民有一项或多项AED医嘱，这一现患率比在社区中发现的高出10倍。在对与AED治疗相关因素的多变量分析中，癫痫指征是最重要的因素，且年龄与AED使用呈负相关。苯妥英是最常用的AED，其次是卡马西平、苯巴比妥和丙戊酸。最常用的联合用药是苯妥英和苯巴比妥。在第二项研究中，评估NH入院数据时发现，8%的新入院居民在进入NH时就已经在接受一种或多种AEDs治疗。该组中与AED使用相关的因素包括癫痫/癫痫发作障碍、年龄、认知能力和躁狂抑郁症（双相情感障碍）。在入院时未使用AED的新入院居民中，3%在入院后3个月内开始使用AED。在此期间与开始使用AED相关的因素中，最强的关联是与癫痫/癫痫发作障碍。躁狂抑郁症（双相情感障碍）也与入院后开始使用AED显著相关。在这组人群中，年龄与开始使用AED呈负相关。
