Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center
ABSTRACT Background: Data on prescribing patterns of antiepileptic drugs (AEDs) to older adult inpatients are limited. Objective: To assess changes in prescribing patterns of AEDs to older adult inpatients with late-onset epilepsy between 2009-2010 and 2015-2019, and to interpret any unexpected...
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Thieme Revinter Publicações
2021-02-01
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| Series: | Arquivos de Neuro-Psiquiatria |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2021000100022&tlng=en |
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| author | Telma ASSIS Aroldo BACELLAR Luan CÔRTES Silas SANTANA Gersonita COSTA Osvaldo NASCIMENTO |
| author_facet | Telma ASSIS Aroldo BACELLAR Luan CÔRTES Silas SANTANA Gersonita COSTA Osvaldo NASCIMENTO |
| author_sort | Telma ASSIS |
| collection | DOAJ |
| description | ABSTRACT Background: Data on prescribing patterns of antiepileptic drugs (AEDs) to older adult inpatients are limited. Objective: To assess changes in prescribing patterns of AEDs to older adult inpatients with late-onset epilepsy between 2009-2010 and 2015-2019, and to interpret any unexpected patterns over the 2015-2019 period. Methods: Patients aged ≥60 years with late-onset epilepsy from a tertiary center were selected. Demographic data, seizure characteristics and etiology, comorbidities, and comedications were analyzed, in addition to prescription regimens of inpatients taking AEDs to treat epilepsy. AED regimens were categorized into two groups: group 1 included appropriate AEDs (carbamazepine, oxcarbazepine, valproic acid, gabapentin, clobazam, lamotrigine, levetiracetam, topiramate, and lacosamide); and group 2 comprised suboptimal AEDs (phenytoin and phenobarbital). Multivariate logistic regression analysis was performed to identify risk factors for prescription of suboptimal AEDs. Results: 134 patients were included in the study (mean age: 77.2±9.6 years). A significant reduction in the prescription of suboptimal AEDs (from 73.3 to 51.5%; p<0.001) was found; however, phenytoin remained the most commonly prescribed AED to older adult inpatients. We also found an increase in the prescription of lamotrigine (from 5.5 to 33.6%) and levetiracetam (from 0 to 29.1%) over time. Convulsive status epilepticus (SE) and acute symptomatic seizures associated with remote and progressive etiologies were risk factors for the prescription of suboptimal AEDs. Conclusions: Phenytoin was the main suboptimal AED prescribed in our population, and convulsive SE and acute symptomatic seizures associated with some etiologies were independent risk factors for phenytoin prescription. These results suggest ongoing commitment to reducing the prescription of suboptimal AEDs, particularly phenytoin in Brazilian emergence rooms. |
| format | Article |
| id | doaj-art-76069a2552ac456d892d8e6bce336064 |
| institution | OA Journals |
| issn | 1678-4227 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | Thieme Revinter Publicações |
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| series | Arquivos de Neuro-Psiquiatria |
| spelling | doaj-art-76069a2552ac456d892d8e6bce3360642025-08-20T01:57:51ZengThieme Revinter PublicaçõesArquivos de Neuro-Psiquiatria1678-42272021-02-01791222910.1590/0004-282x-anp-2020-0012Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary centerTelma ASSIShttps://orcid.org/0000-0002-9943-3396Aroldo BACELLARhttps://orcid.org/0000-0001-8452-0932Luan CÔRTEShttps://orcid.org/0000-0001-8465-1289Silas SANTANAhttps://orcid.org/0000-0001-8291-8445Gersonita COSTAhttps://orcid.org/0000-0002-6715-8035Osvaldo NASCIMENTOhttps://orcid.org/0000-0003-3516-485XABSTRACT Background: Data on prescribing patterns of antiepileptic drugs (AEDs) to older adult inpatients are limited. Objective: To assess changes in prescribing patterns of AEDs to older adult inpatients with late-onset epilepsy between 2009-2010 and 2015-2019, and to interpret any unexpected patterns over the 2015-2019 period. Methods: Patients aged ≥60 years with late-onset epilepsy from a tertiary center were selected. Demographic data, seizure characteristics and etiology, comorbidities, and comedications were analyzed, in addition to prescription regimens of inpatients taking AEDs to treat epilepsy. AED regimens were categorized into two groups: group 1 included appropriate AEDs (carbamazepine, oxcarbazepine, valproic acid, gabapentin, clobazam, lamotrigine, levetiracetam, topiramate, and lacosamide); and group 2 comprised suboptimal AEDs (phenytoin and phenobarbital). Multivariate logistic regression analysis was performed to identify risk factors for prescription of suboptimal AEDs. Results: 134 patients were included in the study (mean age: 77.2±9.6 years). A significant reduction in the prescription of suboptimal AEDs (from 73.3 to 51.5%; p<0.001) was found; however, phenytoin remained the most commonly prescribed AED to older adult inpatients. We also found an increase in the prescription of lamotrigine (from 5.5 to 33.6%) and levetiracetam (from 0 to 29.1%) over time. Convulsive status epilepticus (SE) and acute symptomatic seizures associated with remote and progressive etiologies were risk factors for the prescription of suboptimal AEDs. Conclusions: Phenytoin was the main suboptimal AED prescribed in our population, and convulsive SE and acute symptomatic seizures associated with some etiologies were independent risk factors for phenytoin prescription. These results suggest ongoing commitment to reducing the prescription of suboptimal AEDs, particularly phenytoin in Brazilian emergence rooms.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2021000100022&tlng=enAgedAntiepileptic DrugsEpilepsyInpatientsSeizures |
| spellingShingle | Telma ASSIS Aroldo BACELLAR Luan CÔRTES Silas SANTANA Gersonita COSTA Osvaldo NASCIMENTO Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center Arquivos de Neuro-Psiquiatria Aged Antiepileptic Drugs Epilepsy Inpatients Seizures |
| title | Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center |
| title_full | Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center |
| title_fullStr | Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center |
| title_full_unstemmed | Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center |
| title_short | Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center |
| title_sort | trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a brazilian tertiary center |
| topic | Aged Antiepileptic Drugs Epilepsy Inpatients Seizures |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2021000100022&tlng=en |
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