AN EVALUATION OF ANTIEPILEPTIC DRUG-THERAPY IN NURSING FACILITIES

OBJECTIVES: To describe the prescribing and use of antiepileptic drug (AED) therapy in nursing facility residents. DESIGN: A retrospective, multicenter drug,use evaluation SETTING: A total of 85 nursing facilit ies (average size, 119 beds) in five states. PARTICIPANTS: 1132 reside nts of the total 10,168 residents screened were prescribed at least on e AED MEASURES: Demographic information, primary indication for AED, c omorbid conditions, prescribing physician's specialty, concomitant med ications, and AED dosage regimen information were collected. Laborator y tests obtained in the most recent 6 months and seizure occurrence an d seizure-related diagnostic assessments made in the most recent 3 mon ths were also recorded. RESULTS: Of 1132 residents receiving AED thera py, 892 (78.8%) were prescribed AED therapy for a seizure-related diag nosis although 86% of seizure types were unspecified. Another 215 resi dents (19.0%) were prescribed AEDs for nonseizure diagnoses, and 25 (2 .2%) had no indication for AED therapy. AEDs most frequently prescribe d were phenytoin (56.8%), carbamazepine (23.0%), phenobarbital (15.6%) , and valproic acid (13.1%). For residents with a seizure diagnosis, t he most frequently prescribed monotherapy agents were phenytoin (52.0% ), carbamazepine (12.2%), and phenobarbitol (7.1%). Almost 25% of resi dents with a seizure diagnosis took a combination of AEDs; more than 5 0% of all combinations included phenobarbital. About 9% of residents w ith a seizure diagnosis had one or more documented seizures during a 3 -month review period. CONCLUSION: Among the substantial percentage of residents treated with AEDs, the lack of diagnosis of seizure type has serious implications for the choice of AED therapy. Opportunities exi st for prescribing physicians, consultant pharmacists, and nursing sta ff to improve the medical management of nursing facility residents wit h seizures and of others receiving AEDs.