PDF(Sci-hub)
Abstract：
BACKGROUND: In patients taking antiepileptic drugs (AEDs) for epilepsy, adverse effects (AEs) often lead to unfavorable quality of life, impaired adherence, and, eventually, discontinuation of pharmacological treatment. In a true-to-life sample of subjects from our academic epilepsy outpatient clinic, we aimed to identify predictors for overall high AE burden and for specific AEs focusing on patients on monotherapy.
METHODS: All patients ≥16years of age with epilepsy for ≥12months were routinely asked to complete the Liverpool Adverse Event Profile (LAEP) just before their appointment. Demographic, epilepsy, and treatment variables were derived from our comprehensive outpatient database.
RESULTS: Out of 841 patients, 438 (61% female, mean age: 44.7±17.1years) on monotherapy were included in this study. Levetiracetam (n=151), lamotrigine (n=167), valproic acid (n=73), or controlled-release carbamazepine (n=47) were the most commonly used antiepileptic drugs (AEDs). Independent predictors for general high AE burden (LAEP score≥45) were duration of epilepsy, lack of 12-month seizure freedom, and partial epilepsy, but none of the four individual AEDs. The most frequent LAEP-defined specific AEs were sleepiness, difficulty concentrating, tiredness, and memory problems. The three most frequent independent predictors for each of the 19 AEs were lack of 12-month seizure freedom (13/19 AEs), individual AED (7/19 AEs), and partial epilepsy (6/19 AEs). Levetiracetam was independently associated with anger/aggression, nervousness/agitation, upset stomach, depression, and sleep disturbance; lamotrigine with nervousness/agitation, upset stomach, and difficulty concentrating; and valproic acid with upset stomach and shaky hands.
CONCLUSIONS: Individual AEDs independently predicted some specific AEs, but not overall high AE burden. Our findings may help to characterize patients with epilepsy who are at high risk for specific AEs. Dose reduction or change to another AED may reduce LAEP score and potential nonadherence.
METHODS: All patients ≥16years of age with epilepsy for ≥12months were routinely asked to complete the Liverpool Adverse Event Profile (LAEP) just before their appointment. Demographic, epilepsy, and treatment variables were derived from our comprehensive outpatient database.
RESULTS: Out of 841 patients, 438 (61% female, mean age: 44.7±17.1years) on monotherapy were included in this study. Levetiracetam (n=151), lamotrigine (n=167), valproic acid (n=73), or controlled-release carbamazepine (n=47) were the most commonly used antiepileptic drugs (AEDs). Independent predictors for general high AE burden (LAEP score≥45) were duration of epilepsy, lack of 12-month seizure freedom, and partial epilepsy, but none of the four individual AEDs. The most frequent LAEP-defined specific AEs were sleepiness, difficulty concentrating, tiredness, and memory problems. The three most frequent independent predictors for each of the 19 AEs were lack of 12-month seizure freedom (13/19 AEs), individual AED (7/19 AEs), and partial epilepsy (6/19 AEs). Levetiracetam was independently associated with anger/aggression, nervousness/agitation, upset stomach, depression, and sleep disturbance; lamotrigine with nervousness/agitation, upset stomach, and difficulty concentrating; and valproic acid with upset stomach and shaky hands.
CONCLUSIONS: Individual AEDs independently predicted some specific AEs, but not overall high AE burden. Our findings may help to characterize patients with epilepsy who are at high risk for specific AEs. Dose reduction or change to another AED may reduce LAEP score and potential nonadherence.
摘要：
背景：在服用抗癫痫药物（AEDs）治疗癫痫的患者中，不良反应（AE）往往导致不利的生活质量，依从性受损，and,最终,停止药物治疗。在我们的学术癫痫门诊诊所的真实样本中，我们的目的是确定总体高AE负担的预测因子,以及针对单药治疗患者的特定AE的预测因子.
方法：所有年龄≥16岁的癫痫患者≥12个月，常规要求他们在预约前完成利物浦不良事件简介（LAEP）。人口统计,癫痫,治疗变量来自我们综合的门诊数据库.
结果：在841名患者中，438（61%为女性，本研究包括单药治疗的平均年龄：44.7±17.1岁）。左乙拉西坦（n=151），拉莫三嗪（n=167），丙戊酸（n=73），或控释卡马西平（n=47）是最常用的抗癫痫药物（AEDs）。一般高AE负担（LAEP评分≥45）的独立预测因素是癫痫持续时间，缺乏12个月的癫痫发作自由,和部分性癫痫，但四个单独的AED都没有.最常见的LAEP定义的特异性AE是嗜睡，难以集中注意力,疲倦,和记忆问题。19个AE中每个AE的三个最常见的独立预测因子是缺乏12个月的癫痫发作自由（13/19个AE），个人AED（7/19AE），和部分癫痫（6/19AE）。左乙拉西坦与愤怒/侵略独立相关，紧张/激动，胃部不适,抑郁症,和睡眠障碍；拉莫三嗪伴有紧张/激动，胃部不适,难以集中注意力；丙戊酸胃部不适，手颤抖。
结论：个体AED独立预测了一些特定的AE，但总体AE负担不高。我们的发现可能有助于表征癫痫患者的特异性AE高风险。剂量减少或改为另一种AED可能会降低LAEP评分和潜在的不依从性。
方法：所有年龄≥16岁的癫痫患者≥12个月，常规要求他们在预约前完成利物浦不良事件简介（LAEP）。人口统计,癫痫,治疗变量来自我们综合的门诊数据库.
结果：在841名患者中，438（61%为女性，本研究包括单药治疗的平均年龄：44.7±17.1岁）。左乙拉西坦（n=151），拉莫三嗪（n=167），丙戊酸（n=73），或控释卡马西平（n=47）是最常用的抗癫痫药物（AEDs）。一般高AE负担（LAEP评分≥45）的独立预测因素是癫痫持续时间，缺乏12个月的癫痫发作自由,和部分性癫痫，但四个单独的AED都没有.最常见的LAEP定义的特异性AE是嗜睡，难以集中注意力,疲倦,和记忆问题。19个AE中每个AE的三个最常见的独立预测因子是缺乏12个月的癫痫发作自由（13/19个AE），个人AED（7/19AE），和部分癫痫（6/19AE）。左乙拉西坦与愤怒/侵略独立相关，紧张/激动，胃部不适,抑郁症,和睡眠障碍；拉莫三嗪伴有紧张/激动，胃部不适,难以集中注意力；丙戊酸胃部不适，手颤抖。
结论：个体AED独立预测了一些特定的AE，但总体AE负担不高。我们的发现可能有助于表征癫痫患者的特异性AE高风险。剂量减少或改为另一种AED可能会降低LAEP评分和潜在的不依从性。
