Observational multicentre study into the use of antiepileptic drugs in Spanish neurology consultations

Abstract

Introduction: The study aims to quantify the types of antiepileptic drugs (AED) prescribed in neurology consultations. Methods: This descriptive, observational study included a sample of 559 patients older than 14 years, diagnosed with epilepsy, and receiving pharmacological treatment. Data were collected at outpatient consultations by 47 Spanish neurologists in May 2016. Epilepsy was defined based on the International League Against Epilepsy classification. According to the year of marketing, AEDs were categorised as classic (before 1990) or new (after 1990). We performed a descriptive analysis of qualitative and quantitative variables. Results: Female patients accounted for 54.6% of the sample. Mean age was 42.7 years; mean age of onset was 22.4. Regarding epilepsy type, 75.7% of patients experienced partial seizures, 51.5% were symptomatic, 32.4% had refractory epilepsy, 35.6% had been seizure-free for the previous year, and 59.2% had associated comorbidities.A total of 1103 AED prescriptions were made; 64.6% of prescriptions were for new AEDs; 85.4% of patients received new AEDs. Patients received a mean of 2 AEDs (range, 1–5). A total of 59.6% of patients received polytherapy.The most frequently prescribed AEDs were levetiracetam (42.6%), valproic acid (25.4%), lamotrigine (19.5%), carbamazepine (17.9%), and lacosamide (17.5%). No AED was employed exclusively as monotherapy. The most frequently prescribed AEDs for generalised and partial seizures were valproic acid (48.2%) and levetiracetam (43.2%), respectively. Valproic acid was less frequently prescribed to female patients. Patients with refractory epilepsy or with associated comorbidities were more frequently prescribed a combination of new and classic AEDs (48.7% and 45.6%, respectively) than only one type of AED. Conclusions: The majority of patients received new AEDs. The combination of classic and new AEDs was more frequently prescribed to patients with refractory epilepsy or with associated comorbidities. Resumen: Objetivo: Cuantificar el tipo de fármacos antiepilépticos (FAEs), empleados en epilepsia, en consultas de neurología. Material y método: Estudio descriptivo observacional sobre una muestra de 559 pacientes mayores de 14 años con epilepsia y en tratamiento farmacológico, recogidos en consultas ambulatorias por 47 neurólogos en España en mayo del año 2016.Para las clasificaciones clínicas de la epilepsia se utilizaron las de la Liga Internacional contra la Epilepsia.Los FAEs se clasificaron según el año de comercialización: clásicos (anteriores al 1990) y nuevos (los posteriores).Se realiza análisis descriptivo de las variables cualitativas y cuantitativas. Resultados: Demográficos: 54,6% mujeres; edad media 42,7 años; edad media de inicio de la epilepsia 22,4 años. Clínicos: Predominan las crisis parciales: 75,7%; sintomáticas: 51,5% y con epilepsia farmacoresistente: 32,4%. Pacientes libres de crisis en el último año 35,6%. Comorbilidad asociada 59,2 %. Tratamiento: número de FAEs empleados 1103; 64,6% FAEs nuevos. 85,4% de los pacientes tratados con FAEs nuevos. La media y rango de FAEs empleados: 2 (1–5). 59,6% recibían politerapia.FAEs más utilizados: levetiracetam (LEV) 42,6%, valproico (VPA) 25,4%, lamotrigina (LTG) 19,5%, carbamacepina (CBZ) 17,9% y lacosamida (LCM) 17,5%. Ningún FAE empleado exclusivamente en monoterapia. El más utilizado en crisis generalizadas fue VPA 48,2% y en parciales LEV 43,2%. VPA fue menos utilizado en mujeres. Los pacientes sin control de sus crisis (48,7%) o co-morbilidad asociada (45,6%) recibían la combinación de ambos tipos de FAEs, en mayor porcentaje, que de forma aislada. Conclusiones: La mayoría de pacientes toman FAEs nuevos. La asociación de ambos tipos de FAEs se emplea en mayor medida en los pacientes sin control de sus crisis o co-morbilidad asociada. Keywords: Epilepsy, Epidemiology, Descriptive study, Clinical characteristics, Antiepileptic drugs, Palabras clave: Epilepsia, Epidemiología, Estudio descriptivo, Características clínicas, Fármacos antiepilépticos