Abstracts

Epilepsy is common in the elderly, and previous studies have shown that upon admission 7.7% are receiving an antiepileptic drug (AED) and 3.3% have an AED added after admission¹. This study was done to evaluate the patterns of AED use over a 3-year period in a large nursing home organization., Computerized records containing physician[apos]s daily medication dosing orders and diagnoses were available for a total of 113,047 unique admissions age 65+ years to Beverly Nursing Homes across the USA January 2000 through December 2002. AED information through the 3rd day of admission was analyzed to avoid errors of omission during the first 48 hours., Overall, 6,200 persons (5.48% of all admissions) had an epilepsy/seizure (EPI/SZ) code. There were 73,853 female admissions of which 3,666 (4.96%) had an EPI/SZ code. There were fewer males admitted (39,193) but 6.47% had an EPI/SZ code (p[lt]0.0001). A racial disparity was also noted with Blacks, Hispanics and American Indian/Native Alaskans having a higher prevalence of EPI/SZ code than whites and Asians (p[lt]0.001). 28.5% with an EPI/SZ code were not receiving an AED. The [ldquo]old-old[rdquo] with an EPI/SZ code (85 years+) had lower AED use than the [ldquo]young old[rdquo] (65-74) (p[lt]0.005). Among those with an EPI/SZ code and some AED, use of phenytoin was 66.7%, valproate was 15.3%, Phenobarbital was 9.5%, carbamazepine was 9.7%, gabapentin was 10.3%, and all other new was 4.6% (total [gt]100 % due to polytherapy)., The prevalence of AED use at time of admission to a nursing home is much greater than the 1.5% prevalence in community dwelling elderly, suggesting that a marked increase in the incidence of epilepsy occurs prior to admission. There are significant gender and race differences, with males, Blacks, Hispanics and American Indian/Native Alaskan having higher rates of epilepsy. Phenytoin remains by far the most commonly prescribed AED in this population. However, how the assignment of a EPI/SZ code is made cannot be discerned from this database and the high rate of untreated is problematic. Studies conducted in nursing homes are needed to ascertain the appropriateness of the EPI/SZ coding., (Supported by NIH-NINDS P50 NS16308 ¹Garrard J, etal. Antiepileptic drug use in nursing home admissions. Annals of Neurology 2003:54:75-85.)