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Treatment Strategies in Geriatric Epilepsy

老年癫痫的治疗策略

基本信息

批准号：
10161676
负责人：
Lidia Maria Veras Rocha de Moura
金额：
$ 16.85万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-01 至 2022-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10161676
关键词：
Accounting Address Adherence Adult Adverse effects Adverse event Affect Aftercare Alzheimer&apos s Disease Alzheimer&apos s disease related dementia American Anticonvulsants Award Caregivers Caring Cessation of life Chronic Clinical Clinical Research Clinical Trials Comparative Effectiveness Research Consensus Cost Sharing Data Decision Making Dementia Development Diagnosis Drops Drug Interactions Drug usage Elderly Emergency department visit Epidemiologist Epilepsy Evaluation Event Fee-for-Service Plans Formularies Future Goals Health Policy Hospitalization Individual K-Series Research Career Programs Laboratories Left Legal patent Levetiracetam Life Light Literature Medical Medicare Medicare claim Medication Management Memory impairment Mentorship Metabolic Methodology Modification Monitor Neurodegenerative Disorders Neurologic Neurology Nursing Homes Outcome Patient-Focused Outcomes Patients Pattern Perception Pharmaceutical Preparations Pharmacodynamics Pharmacoepidemiology Pharmacotherapy Phenytoin Physicians Policies Policy Maker Population Population Research Practice Guidelines Pragmatic clinical trial Price Principal Investigator Program Development Provider Public Health Recommendation Recording of previous events Recurrence Regimen Rehabilitation therapy Research Research Design Research Personnel Research Project Grants Risk Safety Sampling Schedule Scientist Seizures Statistical Models Surveys System Techniques Training Translating Treatment Effectiveness Treatment outcome United States Update Variant Vulnerable Populations Work adverse event risk age group age related base beneficiary career development clinical practice comorbidity comparative effectiveness analysis compliance behavior cost disability drug clearance experience expiration high risk hospitalization rates improved instrument large datasets nervous system disorder novel therapeutics older patient person centered prevent programs public health relevance side effect skills treatment adherence treatment center treatment choice treatment comparison treatment strategy

项目摘要

Project Summary/Abstract: Patients with Alzheimer’s disease and related dementias (ADRD) are at high risk for both developing epilepsy and complications associated with its diagnoses and treatments. Of the 5.4 million Americans with Alzheimer's, nearly 10% also have epilepsy. Epilepsy is an incurable, life-threatening neurological disorder characterized by recurrent, spontaneous seizures, which requires anti-seizure drugs that have serious side effects. Inadequate treatment or inadequate adherence to treatment increases the risk of seizures, disability, and early death. Twenty-two anti-seizure drugs are available in the US but the management of epilepsy in the older age group can be complicated by many factors (e.g., development or progression of memory impairment, drug interactions, adverse events). Ideally, treatments should reduce seizure recurrence with minimal treatment complications. There is currently a dearth of information to guide initial treatment among the elderly. This proposed scientific program aims to examine the impact of available treatments for older patients with epilepsy, with a special focus on patients who have co-morbid ADRD. The principal investigator (PI) has three specific research aims: (1) to examine patient adherence to treatment and safety monitoring regimens; (2) to analyze the impact of anti-seizure drugs on seizure recurrence and treatment specific side-effects; and (3) to determine the impact of anti-seizure drugs on clinical event rates such hospitalization or nursing home placement. The PI will use Medicare claims (2006-13) to assess the anti-seizure drugs available to treat new- onset epilepsy, and exploit recent changes in prescription patterns to examine several outcomes. In particular, the PI will compare treatment choices and outcomes among beneficiaries with and without ADRD. The PI proposes a career development program that includes methodological training and mentorship. The PI will utilize advanced statistical modeling to address the challenges posed by comparative effectiveness research applied to epilepsy care under the guidance of experienced clinician-scientists (e.g., Dr. Bradley Hyman), biostatisticians, epidemiologists, and health policy scientists. Career development activities will include training in management and analysis of large datasets, pharmacoepidemiology, causal inference and comparative- effectiveness analysis. These activities will help prepare the PI to develop a pragmatic clinical trial on the initial treatment of new-onset epilepsy in the older patients during the award period. The PI will also take courses in order to effectively translate research findings into improved clinical practice. The long-term goal of this career development award is to develop the candidate into an independent investigator with expertise in clinical and population research and develop the necessary skills needed to conduct high impact research projects for geriatric patients with chronic neurological conditions. This career development award has the potential to fill the unmet public health need for evidence of safe, effective, and person-centered treatments for geriatric neurology patients.

项目摘要/摘要：阿尔茨海默氏病和相关痴呆症 (ADRD) 患者罹患这两种疾病的风险很高癫痫及其诊断和治疗相关的并发症。在 540 万美国人中阿尔茨海默氏症中，近10%还患有癫痫症。癫痫是一种无法治愈、危及生命的神经系统疾病其特点是反复发作、自发性癫痫发作，需要使用具有严重副作用的抗癫痫药物影响。治疗不充分或治疗坚持不充分会增加癫痫、残疾、和早逝。美国有 22 种抗癫痫药物，但癫痫的治疗在美国老年组可能因许多因素而变得复杂（例如，记忆障碍的发生或进展，药物相互作用、不良事件）。理想情况下，治疗应以最小的限度减少癫痫复发治疗并发症。目前缺乏指导老年人初始治疗的信息。这项拟议的科学计划旨在研究现有治疗方法对老年患者的影响癫痫，特别关注患有 ADRD 共病的患者。首席研究员 (PI) 有 3 名具体研究目的：（1）检查患者对治疗和安全监测方案的依从性； (2) 至分析抗癫痫药物对癫痫复发和治疗特定副作用的影响； (3) 至确定抗癫痫药物对住院或疗养院等临床事件发生率的影响放置。 PI 将使用 Medicare 索赔（2006-13）来评估可用于治疗新发的抗癫痫药物：癫痫发作，并利用处方模式的最新变化来检查几种结果。尤其， PI 将比较患有和不患有 ADRD 的受益人的治疗选择和结果。 PI 提出了一项职业发展计划，其中包括方法培训和指导。 PI 将利用先进的统计模型来解决比较有效性研究带来的挑战在经验丰富的临床医生科学家（例如 Bradley Hyman 博士）的指导下应用于癫痫护理，生物统计学家、流行病学家和卫生政策科学家。职业发展活动将包括培训在大型数据集的管理和分析、药物流行病学、因果推理和比较方面有效性分析。这些活动将帮助 PI 做好准备，在初始阶段开展务实的临床试验。奖励期间老年患者新发癫痫的治疗。 PI 还将参加以下课程为了有效地将研究成果转化为改进的临床实践。该职业发展奖的长期目标是将候选人培养成独立的人具有临床和人口研究专业知识的研究者，并培养必要的技能为患有慢性神经系统疾病的老年患者开展高影响力的研究项目。这个职业发展奖有可能满足未满足的公共卫生需求，即安全、有效和可靠的证据针对老年神经科患者的以人为本的治疗。