Pharmacoepidemiological Study of 427 Patients with Epilepsy


Authors: E. Tlustá 1;  J. Zárubová 2;  J. Šimko 3;  H. Hojdíková 3;  J. Vlček 1
Authors‘ workplace: Katedra sociální a klinické farmacie FaF UK Hradec Králové 1;  Centrum pro epileptologii a epileptochirurgii, Fakultní Thomayerova nemocnice, Praha 2;  Neurologická klinika LF UK a FN Hradec Králové 3
Published in: Cesk Slov Neurol N 2008; 71/104(6): 682-687
Category: Original Paper

Overview

Objective:
To analyze a group of patients with epilepsy from two neurology departments in the Czech Republic; to describe type and seizure frequency, antiepileptic drug (AED) therapy and employability of the patients.

Methods:
Epileptic outpatients (n = 427) aged over 16 years receiving AED therapy attending the Neurology Department in Hradec Králové or the Centre for Epileptology and Epileptosurgery at Thomayer’s Teaching Hospital in Prague were considered for analysis. In the period from April 2005 to June 2006, age, gender, type and frequency of epileptic seizures, AEDs data and employability were retrieved from medical records.

Results:
The mean age of the patients was 40.9 years; 57.1% were women. Approximately half of the patients were at least one year without seizures; more than one seizure per month occurred in 24,8% of patients. Partial seizures were diagnosed in 70,7% of patients, 60% of patients were treated with a combination of two or more AEDs. Sodium valproate was the most commonly prescribed AED (54.8%), followed by carbamazepine (37.0%) and lamotrigin (36.3%). One third of the patients were on disability pension.

Conclusions:
The most frequently prescribed AEDs were valproate, followed by carbamazepine and lamotrigin. The study has shown low prescription of old AEDs such as barbiturates and phenytoin. Lamotrigin, levetiracetam and topiramate were the most frequently used new AEDs. AED therapy was in accordance with recent studies and guidelines for AED treatment of epilepsy. Polytherapy was a frequently used regimen in the treatment of epilepsy corresponding to a large number of patients with a difficult-to-treat epilepsy referred to these two epilepsy centers. A high number of patients on disability pension has been found in our group of patients.

Keywords:
epilepsy – antiepileptic drugs – drug utilization


Sources

1. Forsgren L, Beghi E, Oun A, Sillanpää M. The epidemiology of epilepsy in Europe – a systematic review. Eur J Neurol 2005; 12(4): 245–253.

2. Sander JW, Shorvon SD. Epidemiology of the epilepsies. J Neurol Neurosurg Psychiatry 1996; 61(5): 433–443.

3. Collaborative Group for the Study of Epilepsy. Prognosis of epilepsy in newly referred patients: a multicenter prospective study of the effects of monotherapy on the long‑term course of epilepsy. Epilepsia 1992; 33(1): 45–51.

4. Stephen LJ, Kelly K, Mohanraj R, Brodie MJ. Pharmacological outcomes in older people with newly diagnosed epilepsy. Epilepsy Behav 2006; 8(2): 434–437.

5. Mohanraj R, Brodie MJ. Pharmacological outcomes in newly diagnosed epilepsy. Epilepsy Behav 2005; 6(3): 382–387.

6. Kwan P, Brodie MJ. Effectiveness of first antiepileptic drug. Epilepsia 2001; 42(10): 1255–1260.

7. French JA. Refractory epilepsy: clinical overview. Epilepsia 2007; 48 (Suppl 1): 3–7.

8. Kwan P, Sander JW. The natural history of epilepsy: an epidemiological view. J Neurol Neurosurg Psychiatry 2004; 75(10): 1376–1381.

9. Hovorka J, Herman E, Nežádal T. Epilepsie a základy antiepileptické léčby – část 1.Diagnostika a léčba. Psychiat pro praxi 2004; 3: 123–130.

10. Bialer M. The pharmacokinetics and interactions of new antiepileptic drugs: an overview. Ther Drug Monit 2005; 27(6): 722–726.

11. LaRoche SM, Helmers SL. The new antiepileptic drugs: scientific review. JAMA 2004; 291(5): 605–614.

12. Kwan P, Brodie MJ. Clinical trials of antiepileptic medications in newly diagnosed patients with epilepsy. Neurology 2003; 60 (11 Suppl 4): S2–12.

13. Rektor I. Stará a nová antiepileptika u dospělých. Neurologie pro praxi 2002; 2(3): 76–81.

14. Epistop, Mediforum. Soubor minimálních diagnostických a terapeutických standardů u pacientů s epilepsií I–VIII. Praha: Maxdorf 2004.

15. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981; 22(4): 489–501.

16. Keränen T, Riekkinen PJ, Sillanpää M. Incidence and prevalence of epilepsy in adults in eastern Finland. Epilepsia 1989; 30(4): 413–421.

17. Forsgren L. Prevalence of epilepsy in adults in northern Sweden. Epilepsia 1992; 33(3): 450–458.

18. de la Court A, Breteler MM, Meinardi H,Hauser WA, Hofman A. Prevalence of epilepsy in the elderly: the Rotterdam Study. Epilepsia 1996; 37(2): 141–147.

19. Oun A, Haldre S, Mägi M. Prevalence of adult epilepsy in Estonia. Epilepsy Res 2003; 52(3): 233–242.

20. Deckers CL. Overtreatment in adults with epilepsy. Epilepsy Res 2002; 52(1): 43–52.

21. Lhatoo SD, Sander JW, Shorvon SD. The dynamics of drug treatment in epilepsy: an observational study in an unselected population based cohort with newly diagnosed epilepsy followed up prospectively over 11–14 years. J Neurol Neurosurg Psychiatry 2001; 71(5): 632–637.

22. Perucca E, Kwan P. Overtreatment in epilepsy: how it occurs and how it can be avoided. CNS Drugs 2005; 19(11): 897–908.

23. Kořístkova B, Grundmann M. Spotřeba antiepileptik v letech 1993–2004 s využitím různých přístupů. Ceska Slov Farm 2006; 55(1): 18–23.

24. Tlustá E, Ulmanová D, Vitásek Z, Vlček J.Sledování spotřeby starších a nových antiepileptik v České republice v období 1999–2004. Ceska Slov Farm 2007; 56(1): 37–41.

25. Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C et al. ILAE treatment guidelines: evidence‑based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2006; 47(7): 1094–1120.

26. French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL et al. Efficacy and tolerability of the new antiepileptic drugs, II: Treatment of refractory epilepsy: report of the TTA and QSS Subcommittees of the American Academy of Neurology and the American Epilepsy Society. Epilepsia 2004; 45(4): 410–423.

27. Beghi E, Annegers JF, Collaborative Group for the Pregnancy Registries in Epilepsy. Pregnancy registries in epilepsy. Epilepsia 2001; 42(11): 1422–1425.

28. Legros B, Boon P, Dejonghe P, Sadzot B,Van Rijckevorsel K, Schmedding E. Opinion of Belgian neurologists on antiepileptic drugs: Belgian Study on Epilepsy Treatment (BESET). Acta Neurol Scand 2007; 115(2): 97–103.

29. Karceski S, Morrell MJ, Carpenter D. Treatment of epilepsy in adults: expert opinion, 2005. Epilepsy Behav 2005; 7 (Suppl 1):S1–64; quiz S65–67.

30. Sajatovic M, Ramsay E, Nanry K, Thompson T. Lamotrigine therapy in elderly patients with epilepsy, bipolar disorder or dementia. Int J Geriatr Psychiatry 2007; 22(10): 945–950.

31. Lacerda G, Krummel T, Sabourdy C, Ryvlin P, Hirsch E. Optimizing therapy of seizures in patients with renal or hepatic dysfunction. Neurology 2006; 67 (12 Suppl 4):S28–S33.

32. Simpson DM, McArthur JC, Olney R, Clifford D, So Y, Ross D et al. Lamotrigine for HIV‑associated painful sensory neuropathies: a placebo–controlled trial. Neurology 2003; 60(9): 1508–1514.

33. Patsalos PN, Fröscher W, Pisani F, van Rijn CM. The importance of drug interactions in epilepsy therapy. Epilepsia 2002; 43(4): 365–385.

34. Kwan P, Brodie MJ. Combination therapy in epilepsy: when and what to use. Drugs 2006; 66(14): 1817–1829.

35. Pugh MJ, Cramer J, Knoefel J, Charbonneau A, Mandell A, Kazis L et al. Potentially inappropriate antiepileptic drugs for elderly patients with epilepsy. J Am Geriatr Soc 2004; 52(3): 417–422.

36. Leppik IE. Epilepsy in the elderly. Epilepsia 2006; 47 (Suppl 1): 65–70.

37. Trost LF jr, Wender RC, Suter CC, Rosenberg JH, Brixner DI, Von Worley AM et al. Management of epilepsy in adults. Diagnosis guidelines. Postgrad Med 2005; 118(8): 22–26.

38. Kuzniecky RI. Neuroimaging of epilepsy: therapeutic implications. NeuroRx 2005; (2): 384–393.

39. Český statistický úřad. Starobní a invalidní důchodci podle průměrné výše důchodu (v  Kč), 31. 12. 2006 (Zdroj MPSV ČR). [online] 2007 [cited 2008 Jan 2]. Available from: http://www.czso.cz/csu/cizinci.nsf/tab/69002C93AB.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 6

2008 Issue 6

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account