Treatment Strategies in Geriatric Epilepsy

项目概要/摘要： 阿尔茨海默氏病和相关痴呆（ADRD）患者发生以下两种疾病的风险很高： 癫痫及其并发症的诊断和治疗。在540万美国人中 阿尔茨海默氏症，近10%也有癫痫。癫痫是一种无法治愈的，危及生命的神经系统疾病 其特征是反复发作，自发性癫痫发作，这需要具有严重副作用的抗癫痫药物 方面的影响.治疗不当或治疗依从性差会增加癫痫发作、残疾、 早死。在美国有22种抗癫痫药物，但在美国， 老年组可能由于许多因素而变得复杂（例如，记忆障碍的发展或进展， 药物相互作用、不良事件）。理想情况下，治疗应在最小限度内减少癫痫发作复发 治疗并发症。目前缺乏指导老年人初步治疗的信息。 这项拟议的科学计划旨在研究现有治疗对老年患者的影响， 癫痫，特别关注合并ADRD的患者。主要研究者（PI）有三个 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） 分析抗癫痫药物对癫痫复发和治疗特异性副作用的影响;（3） 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 安置PI将使用医疗保险索赔（2006-13）来评估可用于治疗新发癫痫的抗癫痫药物- 癫痫发作，并利用最近的处方模式的变化，以检查几个结果。特别是， PI将比较有和没有ADRD的受益人的治疗选择和结局。的PI 提出了一个职业发展计划，包括方法培训和指导。PI将 利用先进的统计建模来应对比较有效性研究带来的挑战 在有经验的临床医生-科学家的指导下应用于癫痫护理（例如，布拉德利海曼博士）， 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中，药物流行病学，因果推理和比较- 有效性分析这些活动将帮助PI准备在初始阶段开展务实的临床试验。 在奖励期间治疗老年患者新发癫痫。PI还将参加以下课程： 以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 发展奖有可能填补未满足的公共卫生需要的证据，安全，有效， 以人为本的治疗老年神经病患者。

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.