Prescribing Trends of Antiseizure Drugs in Women Veterans With Epilepsy.
Prescribing Trends of Antiseizure Drugs in Women Veterans With Epilepsy.
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患有癫痫的女性退伍军人的抗癫痫药物处方趋势。
DOI：
10.1093/milmed/usad194
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发表时间：
2023
影响因子：
1.2
通讯作者：
Pugh,MaryJo
中科院分区：
文献类型：
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作者：
Lopez,MariaRaquel;VanCott,AnneC;Amuan,MeganE;Panahi,Samin;Henion,Amy;Pugh,MaryJo
目的抗癫痫药物（asm）经常用于其他适应症，如偏头痛、疼痛综合征和精神疾病。因此，可能的致畸效应受到广泛关注，必须权衡药物施加的风险与治疗疾病的风险。我们的目标是更新家庭医生对育龄癫痫妇女开始ASM的影响。我们假设临床医生会在避免致畸和同时治疗相关合并症的基础上开ASM。方法研究队列来源于01 ~ 19财政年度在退伍军人健康管理局（veterans Health Administration）接受治疗至少3年的癫痫女性退伍军人（WVWE）。治疗方案分为单一疗法和综合疗法。多变量logistic回归检验了人口统计学、军事特征、身体/精神合并症、神经护理和每种ASM使用之间的关系。结果在2,283例年龄在17 - 45岁的WVWE中，大多数（61%）在2019财年接受了单药治疗。常用的ASM包括29%加巴喷丁、27%托吡酯、20%拉莫三嗪、16%左乙拉西坦和8%丙戊酸（VPA）。头痛的合并症诊断预测使用托吡酯和VPA，双相情感障碍预测使用LMT和VPA，疼痛预测加巴喷丁，精神分裂症与使用VPA相关。服用左乙拉西坦和拉莫三嗪的妇女先前接受神经病学治疗的可能性明显更高。结论医学合并症的存在影响ASM的选择。尽管有很高的致畸风险，特别是在患有双相情感障碍和头痛的妇女中，育龄期WVWE仍继续使用vpa。综合家庭医生、心理健康和神经病学的多学科护理可以预防服用ASM的妇女的长期畸形问题。
ObjectiveAntiseizure medications (ASMs) are frequently used for other indications, such as migraine, pain syndromes, and psychiatric disorders. Possible teratogenic effects are therefore of wide concern and the risks imposed by the medications must be weighed against the risk with the disorder treated. It is our objective to update family practitioners on the implications of starting ASM for women with epilepsy during childbearing age. We hypothesized that clinicians would prescribe ASM based on avoiding teratogenesis and treating associated comorbidities simultaneously.MethodsThe study cohort was derived from women veterans with epilepsy (WVWE) prescribed ASM who received Veterans Health Administration care for at least 3 years in Veterans Health Administration between fiscal years (FY)01 and FY19. Regimens were classified as monotherapy or polytherapy. Multivariant logistic regression examined the association between demographics, military characteristics, physical/psychiatric comorbidities, neurological care, and use of each ASM.ResultsAmong 2,283 WVWE, in ages between 17 and 45, the majority (61%) received monotherapy in FY19. Commonly prescribed ASM included 29% gabapentin, 27% topiramate, 20% lamotrigine, 16% levetiracetam, and 8% valproate (VPA). Comorbid diagnosis of headache predicted use of topiramate and VPA, bipolar disease predicted use of LMT and VPA, pain predicted gabapentin, and schizophrenia was associated with VPAs use. Women receiving levetiracetam and lamotrigine were significantly more likely to receive neurology care previously.ConclusionThe presence of medical comorbidities influences the selection of ASM. VPAs use in WVWE during childbearing age continues, despite the high teratogenic risk, especially in women with bipolar disorder and headaches. Multidisciplinary care integrating family practice doctors, mental health, and neurology can prevent the enduring problem of teratogenesis in women taking ASM.