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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(01): 22-29
DOI: 10.1590/0004-282X-anp-2020-0012
ARTICLE

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

Tendências no padrão de prescrição de drogas antiepilépticas em idosos internados em um centro terciário brasileiro
Telma ASSIS 
1   Hospital São Rafael, Department of Neurology, D’Or Institute for Research and Education (IDOR), Salvador BA, Brazil.
,
Aroldo BACELLAR 
1   Hospital São Rafael, Department of Neurology, D’Or Institute for Research and Education (IDOR), Salvador BA, Brazil.
,
Luan CÔRTES 
2   Resident of the Department of Neurology, Hospital São Rafael, Monte Tabor Foundation, Italian-Brazilian Center for Health Promotion, Salvador BA, Brazil.
,
Silas SANTANA 
2   Resident of the Department of Neurology, Hospital São Rafael, Monte Tabor Foundation, Italian-Brazilian Center for Health Promotion, Salvador BA, Brazil.
,
Gersonita COSTA 
1   Hospital São Rafael, Department of Neurology, D’Or Institute for Research and Education (IDOR), Salvador BA, Brazil.
,
Osvaldo NASCIMENTO 
3   Universidade Federal Fluminense, Department of Neurology, Niterói RJ, Brazil.
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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.

RESUMO

Introdução: Os dados referentes à prescrição de drogas antiepilépticas (DAE) em pacientes idosos hospitalizados são limitados. Objetivo: Avaliar as mudanças no padrão de prescrição de DAE em idosos hospitalizados com epilepsia de início tardio, entre 2009-2010 e 2015-2019, e interpretar quaisquer padrões inesperados no período de 2015-2019. Métodos: Foram selecionados pacientes com ≥60 anos com epilepsia de início tardio admitidos em um centro terciário. Analisamos os dados demográficos, as características e etiologia das crises, as comorbidades e as comedicações. Foram avaliados os esquemas de prescrição das DAE no tratamento de epilepsia para pacientes internados. Os regimes de DAE foram categorizados em dois grupos: o grupo 1 incluiu as DAE apropriadas (carbamazepina, oxcarbazepina, ácido valproico, gabapentina, clobazam, lamotrigina, levetiracetam, topiramato e lacosamida); e o grupo 2 compreendeu as DAE subótimas (fenitoína e fenobarbital). A análise de regressão logística multivariada foi realizada para identificar fatores de risco para prescrição de DAE subótimas. Resultados: Foram incluídos 134 pacientes (idade média: 77,2±9,6 anos). Encontramos uma redução significativa do uso das DAE subótimas (73,3 para 51,5%; p<0.001); entretanto, a fenitoína permaneceu sendo a DAE mais prescrita para os idosos hospitalizados. Também encontramos um aumento na prescrição da lamotrigina (5,5 para 33,6%) e do levetiracetam (0 para 29,1%) no período. O estado de mal epiléptico (EME) convulsivo e as crises agudas sintomáticas que estiveram associadas a etiologias remotas e progressivas foram fatores de risco para prescrição de DAE subótimas. Conclusões: A fenitoína foi a principal DAE subótima prescrita em nossa população, e o EME convulsivo e as crises agudas sintomáticas associadas a algumas etiologias foram fatores independentes de risco para a prescrição da fenitoína. Esses resultados sugerem a necessidade de compromisso contínuo para reduzir a prescrição de DAE subótimas, particularmente a fenitoína nas salas de emergência brasileiras.

Keywords:

Aged - Antiepileptic Drugs - Epilepsy - Inpatients - Seizures

Palavras-chave:

Idoso - Anticonvulsivantes - Epilepsia - Paciente Internados - Convulsões

Authors’ contributions:

TA conceived the study idea, designed the methods, collected data, performed statistical analysis, and drafted the manuscript; AB, LC, SS, and GC collected data, examined medical records, and reviewed manuscript drafts; LC also performed the English editing; OJN discussed the study idea, methods, statistical analysis, and results. All authors read, discussed, and approved the final manuscript.


Data availability:

The data used to support the findings of this study are available from the corresponding author upon request.




Publication History

Received: 12 January 2020

Accepted: 27 May 2020

Article published online:
01 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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