Allard Jon, Henley William, Mclean Brendan, Sellers Adrian, Hudson Sharon, Rajakulendran Sanjeev, Pace Adrian, Pashley Sarah, Maguire Melissa, Mohan Monica, Ellawela Shan, Tittensor Phil, Ram Sunil, Bagary Manny, Shankar Rohit
Cornwall Partnership NHS Foundation Trust, United Kingdom.
University of Exeter Medical School, United Kingdom.
Seizure. 2020 Feb 19;76:161-166. doi: 10.1016/j.seizure.2020.02.013.
Epilepsy prevalence is significantly higher in people with Intellectual Disability (ID) compared to people with epilepsy (PWE) from the general population. Increased psychological and behavioural problems, healthcare costs, morbidity, mortality and treatment resistance to antiepileptic drugs (AEDs) is associated with epilepsy in ID populations. Prescribing AEDs for PWE and ID is challenging and influenced heavily by studies conducted with the general population. Our study compares Lacosamide (LCM) response for the ID population to those from the general population; using data from an UK based epilepsy database register (EP ID/PDD AED Register).
Pooled retrospective case notes data for PWE prescribed LCM at 11 UK NHS Trusts were analysed. Participants were classified as per WHO guidance into groups of moderate-profound ID, mild ID and General population. Demographics, concomitant AEDs, starting and maximum dosage, exposure length, adverse effects, dropout rates, seizure frequency were collected. Group differences were reported as odds ratios estimated from univariable logistic regression models.
Of 232 consented participants, 156 were from the general population and 76 had ID (24 mild, 52 moderate-profound). Twelve month withdrawal rates and reasons, efficacy, side-effects, start and maximum doses were similar between the groups. Dose titration between baseline and three months was significantly slower in the ID group (p = 0.02).
There were no differences for LCM outcomes between general and ID groups. Slower LCM titration in ID populations in the first 3 months was associated with higher retention and lower behavioural side effects as compared to similar European studies.
与普通人群中的癫痫患者（PWE）相比，智力残疾（ID）人群中的癫痫患病率显著更高。ID人群中癫痫与心理和行为问题增加、医疗费用、发病率、死亡率以及对抗癫痫药物（AEDs）的治疗抵抗相关。为PWE和ID患者开具AEDs具有挑战性，并且很大程度上受到针对普通人群开展的研究的影响。我们的研究比较了ID人群与普通人群对拉考沙胺（LCM）的反应；使用来自英国癫痫数据库登记处（EP ID/PDD AED登记处）的数据。
对英国11个国民健康服务信托基金为PWE开具LCM的汇总回顾性病例记录数据进行分析。参与者根据世界卫生组织的指导方针分为中度至重度ID组、轻度ID组和普通人群组。收集人口统计学信息、伴随使用的AEDs、起始和最大剂量、暴露时长、不良反应、退出率、癫痫发作频率。组间差异以单变量逻辑回归模型估计的比值比报告。
在232名同意参与的参与者中，156名来自普通人群，76名有ID（24名轻度，52名中度至重度）。各组之间的12个月停药率及原因、疗效、副作用、起始和最大剂量相似。ID组在基线和三个月之间的剂量滴定明显较慢（p = 0.02）。
普通人群组和ID组之间LCM的结果没有差异。与欧洲类似研究相比，ID人群在最初3个月LCM滴定较慢与更高的保留率和更低的行为副作用相关。
