Piña-Garza J Eric, Montouris Georgia D, Vekeman Francis, Cheng Wendy Y, Tuttle Edward, Giguere-Duval Philippe, Duh Mei Sheng, Shen Vivienne, Saurer Timothy B, Isojarvi Jouko
The Children's Hospital at TriStar Centennial Medical Center, Nashville, TN, USA.
Boston University School of Medicine, Boston, MA, USA.
Epilepsy Behav. 2017 Aug;73:46-50. doi: 10.1016/j.yebeh.2017.05.021. Epub 2017 Jun 10.
Lennox-Gastaut syndrome (LGS) is a chronic and severe form of epilepsy characterized by intractable seizures, cognitive impairment, and abnormal electroencephalogram findings with slow spike-wave complexes. It typically presents before age 8, but symptoms continue into adulthood and require lifelong treatment associated with significant clinical burden. Data on LGS-associated healthcare utilization and costs are limited. In this study we use a claims-based LGS classifier based on random forest methodology to identify patients with probable LGS from the a Medicaid multi-state database and assess its prevalence across the age spectrum, healthcare utilization, treatment patterns, costs, and comorbid conditions. The classifier identified patients with probable LGS across all ages, with up to 8% of 10-year-old patients with epilepsy identified as having probable LGS. The prevalence of probable LGS was lower in older age cohorts, indicating that it may be under-recognized in older patients. Our analysis showed that probable LGS is associated with considerably higher total healthcare and medical costs than non-LGS patients. The costs were generally consistent between age cohorts, suggesting that the cost burden extends beyond childhood and has a lifelong impact. Analysis of treatment patterns suggest that while the majority of probable LGS patients in this study received widest-spectrum AEDs, a considerable proportion did not and therefore may have been inadequately treated. Further, usage of clobazam and rufinamide was decreased in older compared to younger patient cohorts, indicating that older patient cohorts are less likely to be receiving optimum treatment for LGS. These findings indicate the need for increased clinical attention to LGS beyond pediatric years, with a focus on optimization of treatment for LGS patients of all ages with widest-spectrum AEDs. Timely recognition and adequate treatment of LGS are likely to result in improved outcomes and less costly management of this condition.
伦诺克斯 - 加斯托综合征（LGS）是一种慢性重症癫痫，其特征为顽固性癫痫发作、认知障碍以及脑电图显示有慢棘波复合波异常。该病通常在8岁前发病，但症状会持续至成年，需要终身治疗，临床负担较重。关于LGS相关的医疗服务利用情况和费用的数据有限。在本研究中，我们使用基于随机森林方法的基于索赔的LGS分类器，从一个医疗补助多州数据库中识别可能患有LGS的患者，并评估其在各年龄段的患病率、医疗服务利用情况、治疗模式、费用及合并症。该分类器识别出了各年龄段可能患有LGS的患者，在10岁的癫痫患者中，高达8%被确定可能患有LGS。年龄较大的队列中可能患有LGS的患病率较低，这表明老年患者可能未得到充分诊断。我们的分析表明，与非LGS患者相比，可能患有LGS的患者的总医疗保健和医疗费用要高得多。各年龄队列的费用总体一致，这表明费用负担不仅限于儿童期，而是具有终身影响。对治疗模式的分析表明，虽然本研究中大多数可能患有LGS的患者接受了最广谱的抗癫痫药物（AEDs）治疗，但仍有相当一部分患者未接受此类治疗，因此可能治疗不充分。此外，与年轻患者队列相比，老年患者队列中氯巴占和卢非酰胺的使用量有所减少，这表明老年患者队列接受LGS最佳治疗的可能性较小。这些发现表明，除了儿童期外，还需要在临床中更多关注LGS，重点是为所有年龄段的LGS患者优化使用最广谱的AEDs进行治疗。及时识别和充分治疗LGS可能会改善治疗效果，并降低该病的管理成本。
