Antiepileptic drugs patterns in elderly inpatients in a Brazilian tertiary center, Salvador, Brazil

Abstract

Epilepsy is very prevalent among elderly inpatients and treatment is far from ideal. Objective: To analyze prescribing patterns of antiepileptic drugs (AEDs) for hospitalized elderly with epilepsy, their relations with comorbidities and comedications. Method: We assessed prescription regimen of elderly patients that were under AED use for treatment of epileptic seizures, during hospitalization. One hundred and nine patients were enrolled. AED regimen was categorized into two groups: Group 1 defined as appropriate (carbamazepine, oxcarbazepine, valproic acid, gabapentin, clobazan and lamotrigine) and Group 2 as inappropriate (phenytoin and phenobarbital). Results: We found 73.4% of patients used inappropriate AEDs (p,0.001). Monotherapy was prescribed for 71.6% of patients. The most common comorbidity was hypertension. Potentially proconvulsant drugs as comedications were used for nearly half of patients. Conclusion: Inappropriate AED therapy was commonly prescribed regimen for elderly inpatients. Some recommendations are discussed for a better care of elderly inpatients with epilepsy.Keywords: antiepileptic drugs, elderly, epilepsy, epileptic seizures. RESUMOEpilepsia é frequente entre idosos hospitalizados e o tratamento costuma ser aquém do ideal. Objetivo: Analisar os padrões de prescrição de drogas antiepilépticas para idosos hospitalizados com epilepsia, bem como sua relação com comorbidades e comedicações. Método: Revisamos os prontuários de pacientes idosos internados com diagnóstico de epilepsia e que estavam em uso de droga antiepiléptica (DAE) durante o período de hospitalização. Cento e nove pacientes foram incluídos no estudo. O regime de DAE foi categorizado em dois grupos: Grupo 1, definido como apropriado (carbamazepina, oxcarbazepina, ácido valpróico, gabapentina, clobazam e lamotrigina) e Grupo 2, como inapropriado (fenitoína e fenobarbital). Resultados: 73,4% dos pacientes usaram DAE inapropriadas (p,0,001). Regime de monoterapia foi usado por 71,6% dos pacientes. Hipertensão arterial foi a comorbidade mais frequente. Medicações concomitantes potencialmente proconvulsivantes foram usadas por quase metade desta população. Conclusão: Regime de droga antiepiléptica inapropriada foi o mais utilizado em pacientes idosos internados. São discutidas algumas recomendações para melhor cuidado ao paciente idoso hospitalizado com epilepsia.Palavras-chave: drogas antiepilépticas, idosos, epilepsia, crises epilépticas.

Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center

“…A prior study was conducted to investigate prescribing patterns of AEDs for older adult inpatients with late-onset epilepsy and found that the most common AED prescribed to that population was phenytoin (53%) 12 , which is consistent with several studies also showing phenytoin as the most commonly prescribed AED (50-70%) 9,13 . Notwithstanding guidelines and expert consensus opinions advocating the use of newer AEDs in the treatment of epilepsy among older people, these patients still receive suboptimal treatment in clinical practice.…”

“…To investigate trends in prescribing patterns of AEDs, the AEDs prescribed to the study cohort of older adult inpatients with late-onset epilepsy between 2015 and 2019 (Y2) were identified and these data were compared to results of the previous retrospective study on a similar population conducted between 2009 and 2010 (Y1) 12 . Patient characteristics were also analyzed to identify any risk factor for receiving suboptimal therapy.…”

Clinical features and prognosis of epilepsy in the elderly in western China

“…Older people with epilepsy use more co-medications than younger people [28]. In our cohort, around 25% of all patients took at least one medication that was potentially pro-convulsant.…”

Activities of daily living are associated with outcomes of epilepsy treatment in elderly patients

“…Levetiracetam, lamotrigine, gabapentin, and carbamazepine are recommended for elderly individuals with epilepsy . However, in reality, these recommendations are not followed; VPA and phenytoin are used widely in this population around the world, although most elderly individuals with epilepsy show focal‐onset seizures. VPA is also known to have a risk of inducing coagulopathy, and it should therefore be avoided for elderly patients because of the risk of stroke.…”