Abstracts

Rationale: NHS Tayside provides health services for Dundee, which has a catchment population of 600,000. We wanted to look at use of Anti epilepstic drugs in our area. Prescription of all drugs issued for the health board are recorded on the ""Prescribing Information System,an Information Services Division Scotland database collating all the information on scanned prescriptions prescribed by GPs/pharmacists and dispensed by community pharmacies. We assessed the reasons for prescription of AEDs in our area outwith epilepsy, the range of polypharmacy and in particular whether the latest European guidance on the prescription of valproate was reflected in our patient group.Methods: We obtained necessary permissions to access data of patients over the age of 14 and married the prescriptions to clinical notes either in electronic or paper format.The cohort of patients were selected from AED prescriptions from the period 01/01/2014-31/07/2014 provided by the NHS Tayside Pharmacy Department. To make the data more manageable, patients prescribed gabapentin and/or pregabalin only or in combination were eliminated from the initial patient cohort as the indication for monotherapy pregabalin or gabapentin prescribing was most likely to be neuropathic pain rather than epilepsy.Clinical notes were searched to confirm or refute a diagnosis of epilepsy,which was then classified as-Focal or Generalised epilepsy and assess medication parameters-Drug type, Number of drugs.Results: 16452 patients were identified for 6 months,10142 patients were then eliminated as a result of gabapentin/pregabalin monotherapy, leaving 6310 patients (38% of all AEDs, 3420 females and 2890 males). Data has been collected from 3270 patients ( 51.8%) of the cohort) from electronic records. 908 patients had no electronic records and were not studied yet. Of the remaining 2362 patients:1324 had a diagnosis of epilepsy (56%) and it was possible to tell seizure type from the notes. 502 patients were on monotherapy while 822 were on 2 or more AEDs.1038 were prescribed AEDS but did not have epilepsy (44%). This sub-group audit is still ongoing but common indications for prescription included Migraine/ headaches, Tremor, Neuropathic pain, Anxiety & depression, Bipolar disorder, Schizophrenia. 1499 prescriptions of sodium valproate were made during the 6 months period (825 male ,674 female). 312/674 were aged 14-54 years old, representing a total of 46.3% of total females on sodium valproate.Conclusions: A large number of AEDs are given for non-epilepsy reasons, particularly neuropathic pain using gabapentin or pregabalin. Within this cohort, sodium valproate was prescribed to 1499 patients (674 female)- and 46% were potentially of child bearing age, which has implications for side-effects and teratogenicity, in addition to conflicting with current guidance. Further analysis of the data is required to determine who commonly prescribes valproate in this group and further training and awareness may be required to improve recognition of the potential for harm that may result from its prescription.