title: Antiepileptic drug use and epileptic seizures in nursing home residents in the Province of Pavia, Italy: A reappraisal 12 years after a first survey.
abstract: OBJECTIVE
  To assess the prevalence of epileptic seizures, and antiepileptic drug (AED) use among nursing home elderly residents; to evaluate demographics, seizure characteristics, and seizure-related comorbidities associated with institutionalization; and to compare findings with a previous survey conducted 12 years earlier.
  
  
  METHODS
  Data on demographics, age at institutionalization, diagnoses, functional and cognitive status (Barthel Index and Mini Mental State Examination) and drug treatment were obtained by review of medical records of all individuals aged ≥ 60 years at 21 nursing homes. Data from individuals with a diagnosis of epileptic seizures and AED users were compared with non-seizure, non-AED individuals.
  
  
  RESULTS
  Among the 2163 individuals surveyed (79% females, age at observation 84.9 ± 7.8 years, mean ± SD), 278 (12.8%, vs 4.3% in the previous survey) received chronic AED treatment, including 174 who did not have a diagnosis of seizures. Of the 116 residents with a diagnosis of seizures (5.4%, vs 2.9% in the previous study), 104 were on AED treatment and were younger and had lower cognitive abilities, and a higher number of comorbidities and co-medications compared with non-AED-users. The most commonly prescribed AEDs in seizure individuals were phenobarbital (43.3%, vs 70% in the previous survey) and levetiracetam (27.9%, not available at the time of previous survey). At multivariate analysis, a diagnosis of seizures was found to be associated with younger age at the time of the survey, a history of neurological (cerebrovascular events, meningiomas) and non-neurological conditions (psoriasis and chronic bronchitis), and a lower MMSE score.
  
  
  CONCLUSIONS
  The prevalence of seizures and AED use was higher than in our previous survey and more aligned with data from other countries. Seizures, AED use and co-morbidities were associated with earlier institutionalization. There were indicators of treatment being suboptimal in many cases.
authors.affiliation: Epilepsy Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy. Electronic address: carloandrea.galimberti@mondino.it.
authors.forename: Carlo Andrea
authors.initials: CA
authors.lastname: Galimberti
authors.affiliation: Epilepsy Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Tartara
authors.affiliation: Epilepsy Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Dispenza
authors.affiliation: Epilepsy Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marchese
authors.affiliation: Epilepsy Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
authors.forename: Erminio
authors.initials: E
authors.lastname: Bonizzoni
authors.affiliation: Epilepsy Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Perucca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use*; D015897:Comorbidity; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015995:Prevalence; D012640:Seizures / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drugs; Comorbidities; Elderly; Epilepsy; Institutionalization; Nursing homes