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Bernal Cobo R, Giraldo Tapias LM, Gómez Escobar T, Rueda Cárdenas LF, Zapata Berruecos JF, Vásquez Trespalacios EM, Giraldo Castrillón YM, Rojas-Gualdrón DF. Factors involved in time reduction between seizure relapses in patients with epilepsy attending emergency rooms in Medellín, Colombia. Epilepsy Behav 2022; 126:108458. [PMID: 34906900 DOI: 10.1016/j.yebeh.2021.108458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/08/2021] [Accepted: 11/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Seizure relapses are the leading cause of admission to emergency rooms (ER) in people with epilepsy. OBJECTIVE To analyze administrative and clinical factors associated with the duration between seizure relapses in people with epilepsy admitted to the Neurological Institute of Colombia (Medellin) between July 2018 and July 2019. MATERIALS AND METHODS A retrospective follow-up study of 156 patients over 18 years old, diagnosed with epilepsy, and treated for over a year. The outcome variable was the time between seizure relapses, identified through the record of ER attendances. In addition, difficulties in the prescription filling process (delay, omission, or brand change) and clinical characteristics were analyzed as potential associated influence factors. The statistical analysis was performed using the Prentice, Williams & Peterson-Gap Time survival model for recurrent events. Finally, Adjusted Hazard Ratios (aHR) with 95% confidence intervals (95%CI) are also presented. RESULTS One hundred fifty-six patients were analyzed. Their average age of diagnosis was 15.5 years (SD = 22.5), the median number of monthly seizures was 3 (SD = 9.3), and 50.6% were women. Moreover, difficulties in the prescription filling process were associated with a time reduction between seizure relapses (aHR = 2.61; 95%CI 1.49-4.57), showing a similar impact as having a history of three or four types of events (aHR = 2.96; 95%CI 1.23-7.12) and neuropsychiatric comorbidity (aHR = 1.89; 95%CI 1.04-3.54). CONCLUSION Neuropsychiatric comorbidity, history of several types of events, and experiencing difficulties with prescription filling are associated with lower benefit from treatment to control seizure relapses.
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Affiliation(s)
- Rafael Bernal Cobo
- Residente Universidad CES, Instituto Neurológico de Colombia, Medellín, Colombia
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Wang Y, Hou D, Wu X, Qiu L, Chen H, Xin J, Yan Z, Sun M. An intensive education program for caregivers ameliorates anxiety, depression, and quality of life in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis who underwent cortico-amygdalohippocampectomy. Braz J Med Biol Res 2020; 53:e9000. [PMID: 32696820 PMCID: PMC7372948 DOI: 10.1590/1414-431x20209000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/06/2020] [Indexed: 11/21/2022] Open
Abstract
This study aimed to investigate the effect of a caregiver intensive education
program (CIEP) on anxiety, depression, and quality of life (QOL) in patients
with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis
(TLE-MTS) who underwent cortico-amygdalohippocampectomy (CAH). Ninety patients
with drug-resistant TLE-MTS who underwent CAH and their caregivers were
recruited and randomly allocated to the CIEP group or control group as 1:1
ratio. Caregivers received the CIEP program or routine guidance/education
(control group). Anxiety/depression and QOL in patients at month (M)0, M1, M3,
and M6 were assessed by the Hospital Anxiety and Depression Scale (HADS) scale
and the QOL in Epilepsy Inventory-31 (QOLIE-31), respectively. Treatment
efficacy at M6 was assessed by Engel classification. The HADS-anxiety score at
M3 (P=0.049) and M6 (P=0.028), HADS-anxiety score change (M6-M0) (P=0.001),
percentage of anxiety patients at M6 (P=0.025), and anxiety severity at M6
(P=0.011) were all decreased in the CIEP group compared with the control group.
The HADS-depression score at M6 (P=0.033) and HADS-depression score change
(M6-M0) (P=0.022) were reduced, while percentage of depression patients at M6
(P=0.099) and depression severity at M6 (P=0.553) showed no difference in the
CIEP group compared with the control group. The QOLIE-31 score at M6 (P=0.043)
and QOLIE-31 score change (M6-M0) (P=0.010) were both elevated in the CIEP group
compared with the control group. In conclusion, CIEP for caregivers contributed
to the recovery of anxiety and depression as well as the improvement of QOL in
patients with drug-resistant TLE-MTS who underwent CAH.
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Affiliation(s)
- Yuena Wang
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongyu Hou
- Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaohua Wu
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lili Qiu
- Department of Endocrinology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Chen
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianxia Xin
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhirong Yan
- Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Meiling Sun
- Department of Nursing, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
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Fishman J, Martin M, Labiner DM, Lew CR, Johnson BH. Healthcare resource utilization and costs before and after lacosamide initiation as adjunctive therapy among patients with epilepsy in the United States. Epilepsy Behav 2019; 99:106331. [PMID: 31399339 DOI: 10.1016/j.yebeh.2019.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/03/2019] [Accepted: 05/17/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate all-cause and epilepsy-specific healthcare resource utilization and costs following lacosamide (LCM) initiation as adjunctive therapy for the treatment of epilepsy. METHODS A noninterventional retrospective database analysis was conducted that examined patients diagnosed as having epilepsy who added LCM to existing antiepileptic drug (AED) therapy between 2009 and 2016 (the first LCM prescription was the index event). This study used a single-case design whereby patients served as their own controls. Patients were further required to have a minimum of 12 months of continuous eligibility before (preindex period) and after (postindex period) their index event. In the 12-month postindex period, the only allowed AED regimen change was the addition of LCM. Demographic and clinical characteristics were measured at index and during the preindex period, respectively. All-cause and epilepsy-specific healthcare resource utilization and costs were measured and compared in the pre- and postindex periods. Paired t- and McNemar's tests were conducted to assess the significant differences between pre- and postindex. Univariate analyses were used to analyze the impact of LCM on specific subpopulations. RESULTS The study sample comprised of 2171 patients: mean (standard deviation [SD]) age: 38.9 (19.3) years; 52.6% female. Just over half (56%) of these patients were on monotherapy before adding LCM. Prior to adding LCM, 28.8% of patients had an epilepsy-specific inpatient (IP) admission, and 35.7% of patients had an all-cause IP admission, compared with 18.2% and 26.1% of patients in the post-LCM period, respectively (both p < 0.0001). Likewise, 35.6% of patients had an epilepsy-specific emergency room (ER) visit, and 50.0% had an all-cause ER visit prior to adding LCM, compared with 23.8% and 42.1% in post-LCM, respectively (both p < 0.0001). After adding LCM, one-year mean [SD] epilepsy-specific IP admission costs decreased by 42.9% ($13,647 [$52,290] to $7788 [$32,321]), and all-cause IP admission costs decreased by 38.6% ($20,654 [$72,716] to $12,688 [$46,120]) (both p < 0.0001). One-year epilepsy-specific mean [SD] ER costs decreased by 35.2% ($691 [$1756] to $448 [$1909]; p < 0.0001), and all-cause ER cost decreased by 17.8% ($1217 [$3014] to $1000 [$2970]; p < 0.01). CONCLUSIONS Epilepsy-related IP hospitalizations and ER visits (indicators of seizures) were significantly reduced in patients with epilepsy 12 months after adding LCM as an adjunctive therapy to existing AED treatment in a real-world setting, leading to reduced healthcare resource utilization and epilepsy costs.
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Affiliation(s)
| | | | - David M Labiner
- The University of Arizona College of Medicine, Tucson, AZ, USA
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Zhu Y, Wu H, Wang MD. Feature Exploration and Causal Inference on Mortality of Epilepsy Patients Using Insurance Claims Data. ... IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS. IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS 2019; 2019:10.1109/bhi.2019.8834638. [PMID: 32577623 PMCID: PMC7310717 DOI: 10.1109/bhi.2019.8834638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Approximately 0.5-1% of the global population is afflicted with epilepsy, a neurological disorder characterized by repeated seizures. Sudden Unexpected Death in Epilepsy (SUDEP) is a poorly understood complication that claims the lives of nearly 1-in-1000 epilepsy patients every year. This paper aims to explore diagnosis codes, demographic and payment features on mortality of epilepsy patients. We design a mortality prediction model with diagnosis codes and non-diagnosis features extracted from US commercial insurance claims data. We present classification accuracy of 0.91 and 0.85 by using different feature vectors. After analyzing the aforementioned features in prediction model, we extend the work to causal inference between modified diagnosis codes and selected non-diagnosis features. The uplift test of causal inference using three algorithms indicates that a patient is more likely to survive if upgrading from a low-coverage healthcare plan into a high-coverage plan.
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Affiliation(s)
- Yuanda Zhu
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hang Wu
- Dept. of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - May D Wang
- Dept. of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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Chen E, Sajatovic M, Liu H, Bukach A, Tatsuoka C, Welter E, Schmidt SS, Bamps YA, Stoll SC, Spruill TM, Friedman D, Begley CE, Shegog R, Fraser RT, Johnson EK, Jobst BC. Demographic and Clinical Correlates of Seizure Frequency: Findings from the Managing Epilepsy Well Network Database. J Clin Neurol 2018; 14:206-211. [PMID: 29504297 PMCID: PMC5897204 DOI: 10.3988/jcn.2018.14.2.206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/25/2017] [Accepted: 11/28/2017] [Indexed: 01/04/2023] Open
Abstract
Background and Purpose Epilepsy is a chronic neurological disease that represents a tremendous burden on both patients and society in general. Studies have addressed how demographic variables, socioeconomic variables, and psychological comorbidity are related to the quality of life (QOL) of people with epilepsy (PWE). However, there has been less focus on how these factors may differ between patients who exhibit varying degrees of seizure control. This study utilized data from the Managing Epilepsy Well (MEW) Network of the Centers for Disease Control and Prevention with the aim of elucidating differences in demographic variables, depression, and QOL between adult PWE. Methods Demographic variables, depression, and QOL were compared between PWE who experience clinically relevant differences in seizure occurrence. Results Gender, ethnicity, race, education, income, and relationship status did not differ significantly between the seizure-frequency categories (p>0.05). People with worse seizure control were significantly younger (p=0.039), more depressed (as assessed using the Patient Health Questionnaire) (p=0.036), and had lower QOL (as determined using the 10-item Quality of Life in Epilepsy for Adults scale) (p<0.001). Conclusions The present results underscore the importance of early screening, detection, and treatment of depression, since these factors relate to both seizure occurrence and QOL in PWE.
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Affiliation(s)
- Erdong Chen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Hongyan Liu
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ashley Bukach
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Curtis Tatsuoka
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Elisabeth Welter
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Samantha S Schmidt
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Yvan A Bamps
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shelley C Stoll
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA
| | - Tanya M Spruill
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Daniel Friedman
- Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Charles E Begley
- School of Public Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas, Houston, TX, USA
| | - Robert T Fraser
- Departments of Neurology, Neurological Surgery, and Rehabilitation Medicine, Harborview Medical Center, Seattle, WA, USA
| | - Erica K Johnson
- Department of Health Services, Health Promotion Research Center, University of Washington School of Public Health, Seattle, WA, USA
| | - Barbara C Jobst
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Liu X, Carney PR, Bussing R, Segal R, Cottler LB, Winterstein AG. Stimulants Do Not Increase the Risk of Seizure-Related Hospitalizations in Children with Epilepsy. J Child Adolesc Psychopharmacol 2018; 28:111-116. [PMID: 29028437 PMCID: PMC5911707 DOI: 10.1089/cap.2017.0110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the safety of stimulants in children with epilepsy. METHODS In a retrospective cohort study based on Medicaid Analytic eXtract billing records from 26 U.S. states from 1999 to 2010, we identified incident stimulant use among children with epilepsy through outpatient encounter claims and pharmacy claims. We established a control group of nonusers and used frequency matching to generate index dates. We followed both cohorts for 12 months and calculated hazard ratios [HRs] of current and former use of stimulants versus no use on the outcome of seizure-related hospitalization using multivariate Cox proportional hazard models. RESULTS We identified 18,166 stimulant users and 54,197 nonusers in children with epilepsy. The incidence of seizure-related hospitalization in current stimulant users, former users, and nonusers was 3.6, 3.5, and 4.3 per 100 patient-years. After adjustment for confounders, we found current and former use of stimulants did not increase seizure-related hospitalizations (HR 0.95, 95% confidence interval [CI]: 0.83, 1.09 and HR 0.99, 95% CI: 0.85, 1.15). Children with cerebral palsy, congenital nervous system anomalies, or intellectual disability did not have significantly higher HRs than those without the already mentioned comorbidities. CONCLUSION This study has not identified any overall increase in the rate of seizure-related hospitalizations with the use of stimulants in children with epilepsy.
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Affiliation(s)
- Xinyue Liu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Paul R. Carney
- Department of Neurology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Linda B. Cottler
- Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
- Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
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Kwan P, Palmini A. Association between switching antiepileptic drug products and healthcare utilization: A systematic review. Epilepsy Behav 2017. [PMID: 28641169 DOI: 10.1016/j.yebeh.2017.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS There is ongoing concern whether switching between different antiepileptic drug (AED) products may compromise patient care. We systematically reviewed changes in healthcare utilization following AED switch. METHODS We searched MEDLINE and EMBASE databases (1980-October 2016) for studies that assessed the effect of AED switching in patients with epilepsy on outpatient visits, emergency room visits, hospitalization and hospital stay duration. RESULTS A total of 14 articles met the inclusion criteria. All were retrospective studies. Four provided findings for specific AEDs only (lamotrigine, topiramate, phenytoin and divalproex), 9 presented pooled findings from multiple AEDs, and 1 study provided both specific (lamotrigine, topiramate, oxcarbazepine, and levetiracetam) and pooled findings. Three studies found an association between a switch of topiramate and an increase in healthcare utilization. Another three studies found that a brand-to-generic lamotrigine switch was not associated with an increased risk of emergently treated events (ambulance use, ER visits or hospitalization). The outcomes of the pooled AED switch studies were inconsistent; 5 studies reported an increased healthcare utilization while 5 studies did not. CONCLUSION Studies that have examined the association between an AED switch and a change in healthcare utilization report conflicting findings. Factors that may explain these inconsistent outcomes include inter-study differences in the type of analysis undertaken (pooled vs individual AED data), the covariates used for data adjustment, and the type of switch examined. Future medical claim database studies employing a prospective design are encouraged to address these and other factors in order to enhance inter-study comparability and extrapolation of findings.
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Affiliation(s)
- Patrick Kwan
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - André Palmini
- Faculty of Medicine, Neurology Service & Porto Alegre Epilepsy Surgery Program, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
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Comparison of Drug Utilization Patterns in Observational Data: Antiepileptic Drugs in Pediatric Patients. Paediatr Drugs 2015; 17:401-10. [PMID: 26070280 PMCID: PMC4573831 DOI: 10.1007/s40272-015-0139-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Physicians require information on the comparative benefits and harms of medications for optimal treatment decisions. However, this type of data is limited, especially for pediatric patients. OBJECTIVE Our aim was to use observational data to measure and compare medication utilization patterns in a pediatric patient population. METHODS Using pharmacy claims data from a large, national-scale insurance program in the USA, we identified all patients with a diagnosis of epilepsy treated with a first-generation antiepileptic drug (carbamazepine, ethosuximide, phenobarbital, phenytoin, or valproate) or a second-generation antiepileptic drug [carbamazepine extended release (XR), gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, valproate XR, or zonisamide]. Treatment periods were defined on the basis of prescription fill dates and medication days supplied. Medication use was measured for individual antiepileptic drugs and for first-generation and second-generation drugs as groups. RESULTS There were 2527 patients (54 %) who initiated therapy with first-generation antiepileptics and 2139 patients (46 %) who initiated therapy with second-generation antiepileptics. First- and second-generation drugs had the same 1-year retention rates [26 % (95 % confidence interval (CI) 24-28) and 26 % (95 % CI 25-28), respectively], and 26 % of patients (95 % CI 25-28) and 29 % of patients (95 % CI 27-31) who started on a first- or second-generation antiepileptic medication, respectively, resumed treatment with the initial drug after discontinuation. Overall, 73 % of patients (95 % CI 71-74) were treated with only one antiepileptic drug, with similar rates for patients started on first- and second-generation drugs [71 % (95 % CI 69-73) versus 74 % (95 % CI 72-76)]. CONCLUSION Comparing drug utilization patterns in a pediatric population using observational data, we found similar rates of retention and therapeutic changes. These findings are consistent with the available comparative data and demonstrate an approach that could be extended to other drug classes and conditions in pediatric populations to examine drug effectiveness.
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Polard E, Nowak E, Happe A, Biraben A, Oger E. Brand name to generic substitution of antiepileptic drugs does not lead to seizure-related hospitalization: a population-based case-crossover study. Pharmacoepidemiol Drug Saf 2015; 24:1161-9. [DOI: 10.1002/pds.3879] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 08/18/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Elisabeth Polard
- Department of Pharmacology, Pharmacovigilance, Pharmacoepidemiology and Drug Information Center; Rennes University Hospital; Rennes France
- Pharmacoepidemiology team (CTAD-PEPI); Rennes University Hospital; Rennes France
| | - Emmanuel Nowak
- Pharmacoepidemiology team (CTAD-PEPI); Rennes University Hospital; Rennes France
| | - André Happe
- Pharmacoepidemiology team (CTAD-PEPI); Rennes University Hospital; Rennes France
| | - Arnaud Biraben
- Department of Neurology; Rennes University Hospital; Rennes France
| | - Emmanuel Oger
- Department of Pharmacology, Pharmacovigilance, Pharmacoepidemiology and Drug Information Center; Rennes University Hospital; Rennes France
- Pharmacoepidemiology team (CTAD-PEPI); Rennes University Hospital; Rennes France
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