Schachter S C, Cramer G W, Thompson G D, Chaponis R J, Mendelson M A, Lawhorne L
Department of Neurology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts 02215, USA.
J Am Geriatr Soc. 1998 Sep;46(9):1137-41. doi: 10.1111/j.1532-5415.1998.tb06654.x.
To describe the prescribing and use of antiepileptic drug (AED) therapy in nursing facility residents.
A retrospective, multicenter drug use evaluation.
A total of 85 nursing facilities (average size, 119 beds) in five states.
1132 residents of the total 10,168 residents screened were prescribed at least one AED.
Demographic information, primary indication for AED, comorbid conditions, prescribing physician's specialty, concomitant medications, and AED dosage regimen information were collected. Laboratory tests obtained in the most recent 6 months and seizure occurrence and seizure-related diagnostic assessments made in the most recent 3 months were also recorded.
Of 1132 residents receiving AED therapy, 892 (78.8%) were prescribed AED therapy for a seizure-related diagnosis although 86% of seizure types were unspecified. Another 215 residents (19.0%) were prescribed AEDs for nonseizure diagnoses, and 25 (2.2%) had no indication for AED therapy. AEDs most frequently prescribed were phenytoin (56.8%), carbamazepine (23.0%), phenobarbital (15.6%), and valproic acid (13.1%). For residents with a seizure diagnosis, the most frequently prescribed monotherapy agents were phenytoin (52.0%), carbamazepine (12.2%), and phenobarbitol (7.1%). Almost 25% of residents with a seizure diagnosis took a combination of AEDs; more than 50% of all combinations included phenobarbital. About 9% of residents with a seizure diagnosis had one or more documented seizures during a 3-month review period.
Among the substantial percentage of residents treated with AEDs, the lack of diagnosis of seizure type has serious implications for the choice of AED therapy. Opportunities exist for prescribing physicians, consultant pharmacists, and nursing staff to improve the medical management of nursing facility residents with seizures and of others receiving AEDs.
描述护理机构居民中抗癫痫药物（AED）治疗的处方开具及使用情况。
一项回顾性多中心药物使用评估。
五个州的85家护理机构（平均规模为119张床位）。
在总共筛查的10168名居民中，有1132名居民至少被开具了一种AED。
收集人口统计学信息、AED的主要适应证、合并症、开处方医生的专业、伴随用药以及AED剂量方案信息。还记录了最近6个月内进行的实验室检查以及最近3个月内发生的癫痫发作情况和与癫痫发作相关的诊断评估。
在接受AED治疗的1132名居民中，892名（78.8%）因与癫痫相关的诊断而被开具AED治疗，尽管86%的癫痫发作类型未明确。另外215名居民（19.0%）因非癫痫诊断而被开具AED，25名（2.2%）无AED治疗适应证。最常开具的AED是苯妥英（56.8%）、卡马西平（23.0%）、苯巴比妥（15.6%）和丙戊酸（13.1%）。对于有癫痫诊断的居民，最常开具的单一疗法药物是苯妥英（52.0%）、卡马西平（12.2%）和苯巴比妥（7.1%）。近25%有癫痫诊断的居民联合使用AED；所有联合用药中超过50%包含苯巴比妥。在3个月的回顾期内，约9%有癫痫诊断的居民有一次或多次有记录的癫痫发作。
在接受AED治疗的相当比例的居民中，癫痫发作类型缺乏诊断对AED治疗的选择有严重影响。开处方医生、顾问药师和护理人员有机会改善对护理机构中有癫痫发作的居民以及其他接受AED治疗者的医疗管理。
