Treatment Strategies in Geriatric Epilepsy

项目摘要/摘要： 阿尔茨海默病和相关痴呆症(ADRD)患者患这两种疾病的风险都很高 癫痫及与其诊断和治疗相关的并发症。在540万美国人中， 阿尔茨海默氏症患者中，近10%还患有癫痫。癫痫是一种无法治愈、危及生命的神经系统疾病。 以反复发作、自发性发作为特征，这需要有严重副作用的抗癫痫药物 效果。治疗不当或坚持治疗不充分会增加癫痫发作、残疾、 和早逝。美国有22种抗癫痫药物，但美国对癫痫的管理 老年群体可能会因许多因素而复杂化(例如，记忆损伤的发展或进展， 药物相互作用、不良事件)。理想情况下，治疗应尽量减少癫痫复发。 治疗并发症。目前缺乏信息来指导老年人的初步治疗。 这项拟议的科学计划旨在检查可用治疗对老年患者的影响 癫痫，特别关注患有ADRD的患者。首席调查员(PI)有三个 具体研究目标：(1)检查患者对治疗和安全监测方案的依从性；(2) 分析抗癫痫药物对癫痫复发的影响和治疗的具体副作用；及 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 Claims(2006-13)来评估可用于治疗新的- 发作癫痫，并利用最近处方模式的变化来检查几种结果。特别是， PI将比较患有和不患有ADRD的受益者的治疗选择和结果。《少年派》 提出一个职业发展计划，其中包括方法培训和指导。私人侦探将 利用高级统计建模来应对比较有效性研究带来的挑战 在经验丰富的临床科学家(例如，布拉德利·海曼博士)的指导下应用于癫痫治疗， 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 在管理和分析大数据集、药物流行病学、因果推断和比较-- 有效性分析。这些活动将帮助PI做好准备，以便在最初的 获奖期内高龄患者新发癫痫的治疗。私家侦探还将参加 以便有效地将研究成果转化为改进的临床实践。 这个职业发展奖的长期目标是将候选人发展成为一个独立的 具有临床和人口研究专业知识的调查员，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。这份职业 发展奖有可能满足尚未满足的公共卫生需求，即安全、有效和 以人为本的老年神经科患者治疗。

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.