意大利帕维亚省养老院居民的抗癫痫药物使用情况及癫痫发作：首次调查12年后的重新评估

Antiepileptic drug use and epileptic seizures in nursing home residents in the Province of Pavia, Italy: A reappraisal 12 years after a first survey.

作者信息

Galimberti Carlo Andrea, Tartara Elena, Dispenza Sabrina, Marchese Daniele, Bonizzoni Erminio, Perucca Emilio

机构信息

Epilepsy Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.

出版信息

Epilepsy Res. 2016 Jan;119:41-8. doi: 10.1016/j.eplepsyres.2015.11.009. Epub 2015 Dec 1.

DOI:10.1016/j.eplepsyres.2015.11.009

PMID:26656178

Abstract

PURPOSE

To assess the prevalence of epileptic seizures, and antiepileptic drug (AED) use among nursing home elderly residents; to evaluate demographics, seizure characteristics, and seizure-related comorbidities associated with institutionalization; and to compare findings with a previous survey conducted 12 years earlier.

METHODS

Data on demographics, age at institutionalization, diagnoses, functional and cognitive status (Barthel Index and Mini Mental State Examination) and drug treatment were obtained by review of medical records of all individuals aged ≥ 60 years at 21 nursing homes. Data from individuals with a diagnosis of epileptic seizures and AED users were compared with non-seizure, non-AED individuals.

RESULTS

Among the 2163 individuals surveyed (79% females, age at observation 84.9 ± 7.8 years, mean ± SD), 278 (12.8%, vs 4.3% in the previous survey) received chronic AED treatment, including 174 who did not have a diagnosis of seizures. Of the 116 residents with a diagnosis of seizures (5.4%, vs 2.9% in the previous study), 104 were on AED treatment and were younger and had lower cognitive abilities, and a higher number of comorbidities and co-medications compared with non-AED-users. The most commonly prescribed AEDs in seizure individuals were phenobarbital (43.3%, vs 70% in the previous survey) and levetiracetam (27.9%, not available at the time of previous survey). At multivariate analysis, a diagnosis of seizures was found to be associated with younger age at the time of the survey, a history of neurological (cerebrovascular events, meningiomas) and non-neurological conditions (psoriasis and chronic bronchitis), and a lower MMSE score.

CONCLUSIONS

The prevalence of seizures and AED use was higher than in our previous survey and more aligned with data from other countries. Seizures, AED use and co-morbidities were associated with earlier institutionalization. There were indicators of treatment being suboptimal in many cases.

摘要

目的

评估疗养院老年居民中癫痫发作的患病率以及抗癫痫药物（AED）的使用情况；评估与机构化相关的人口统计学特征、发作特点以及与发作相关的合并症；并将研究结果与12年前进行的一项调查进行比较。

方法

通过查阅21家疗养院中所有年龄≥60岁个体的病历，获取有关人口统计学、入住机构时的年龄、诊断、功能和认知状态（Barthel指数和简易精神状态检查表）以及药物治疗的数据。将诊断为癫痫发作的个体和使用AED的个体的数据与无发作、未使用AED的个体进行比较。

结果

在接受调查的2163名个体中（79%为女性，观察时年龄为84.9±7.8岁，均值±标准差），278人（12.8%，而之前的调查为4.3%）接受慢性AED治疗，其中174人没有癫痫发作的诊断。在116名诊断为癫痫发作的居民中（5.4%，而之前的研究为2.9%），104人接受AED治疗，他们年龄更小、认知能力更低，与未使用AED的居民相比，合并症和联合用药的数量更多。癫痫发作个体中最常开具的AED是苯巴比妥（43.3%，而之前的调查为70%）和左乙拉西坦（27.9%，之前调查时没有该药）。在多变量分析中，发现癫痫发作的诊断与调查时较年轻的年龄、神经科病史（脑血管事件、脑膜瘤）和非神经科疾病史（银屑病和慢性支气管炎）以及较低的简易精神状态检查表评分相关。