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Bentes C, Canas N, Pedrosa H, Completo J, Pereira F, Carrilho M, Lopes Lima J, Pereira C, Rego R, Rocha H, Sá F, Sales F, Santos M, Teotónio R. Characterization and quantification of epilepsy patients with hospital episodes in Portugal: A multicenter retrospective study from Liga Portuguesa Contra a Epilepsia. Epilepsy Behav 2024; 155:109771. [PMID: 38642529 DOI: 10.1016/j.yebeh.2024.109771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/06/2024] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Epilepsy affects around 50 million people worldwide and is associated with lower quality of life scores, an increased risk of premature death, and significant socio-economic implications. The lack of updated evidence on current epidemiology and patient characterization creates considerable uncertainty regarding the epilepsy burden in Portugal. The study aims to characterize and quantify the epilepsy patients who have been hospitalized, with medical or surgical procedures involved, and to analyze their associated comorbidities and mortality rates. METHODS A multicenter retrospective study was conducted using hospital production data of epilepsy patients. The study included all patients diagnosed with epilepsy-related International Classification of Diseases-9/10 codes between 2015 and 2018 in 57 Portuguese National Health Service (NHS) hospitals (n = 57 institutions). Patient characterization and quantification were done for all patients with an epilepsy diagnosis, with specific analyses focusing on those whose primary diagnosis was epilepsy. Baseline, demographic, and clinical characteristics were analyzed using descriptive statistics. RESULTS Between 2015 and 2018, a total of 80,494 hospital episodes (i.e., patient visit that generates hospitalization and procedures) were recorded, with 18 % to 19 % directly related to epilepsy. Among these epilepsy-related hospital episodes, 13.0 % led to short term hospitalizations (less than 24 h). Additionally, the average length of stay for all these epilepsy-related episodes was 8 days. A total of 49,481 patients were identified with epilepsy based on ICD-9/10 codes. The median age of patients was 64 years (min: 0; max: 104), with a distribution of 4.8 patients per 1,000 inhabitants. From the total of deaths (9,606) between 2015 and 2018, 14% were associated with patients whose primary diagnosis was epilepsy, with 545 of these being epilepsy-related deaths. Among patients with a primary diagnosis of epilepsy, the most common comorbidities were hypertension (24%) and psychiatric-related or similar comorbidities (15%), such as alcohol dependance, depressive and major depressive disorders, dementia and other convulsions. CONCLUSION This study showed similar results to other European countries. However, due to methodological limitations, a prospective epidemiological study is needed to support this observation. Furthermore, the present study provides a comprehensive picture of hospitalized epilepsy patients in Portugal, their comorbidities, mortality, and hospital procedures.
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Affiliation(s)
- Carla Bentes
- Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, Lisboa, Portugal; Department of Neurosciences and Mental Health (Neurology), Centro Hospitalar Universitário Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal; Egas Moniz Centre of Studies. Medical Faculty, Universidade de Lisboa, Lisboa, Portugal; Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal.
| | - Nuno Canas
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neurology Department, Hospital Beatriz Ângelo, Lisboa, Portugal; Reference Centre for Refractory Epilepsies, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Hugo Pedrosa
- IQVIA Solutions Portugal, RWAS, Oeiras, Portugal
| | - João Completo
- IQVIA Solutions Portugal, IASIST - Payers, Providers and Government, Oeiras, Portugal
| | | | | | - José Lopes Lima
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neurology Department, Hospital Lusíadas Porto, Porto, Portugal; Neurology Department, Hospital da Misericórdia do Porto, Porto, Portugal; Neurology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Pereira
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neuropediatrics and Neurophysiology Department - Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ricardo Rego
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neurophysiology Unit, Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Reference Centre for Refractory Epilepsies, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Helena Rocha
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neurophysiology Unit, Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Reference Centre for Refractory Epilepsies, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Francisca Sá
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Reference Centre for Refractory Epilepsies, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Neurology Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Francisco Sales
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Neurophysiology Unit, Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Manuela Santos
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neuropediatrics Department, Centro Hospitalar e Universitário de Santo António, Porto, Portugal; Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar e Universitário de Santo António, Porto, Portugal
| | - Rute Teotónio
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Neurophysiology Unit, Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Lee K, Klein P, Dongre P, Choi EJ, Rhoney DH. Intravenous Brivaracetam in the Management of Acute Seizures in the Hospital Setting: A Scoping Review. J Intensive Care Med 2022; 37:1133-1145. [PMID: 35306914 PMCID: PMC9393655 DOI: 10.1177/08850666211073598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Clinical considerations for drug treatment of acute seizures involve
variables such as safety, tolerability, drug-drug interactions, dosage,
route of administration, and alterations in pharmacokinetics because of
critical illness. Therapy options that are easily and quickly administered
without dilution, well tolerated, and effective are needed for the treatment
of acute seizures. The objective of this review is to focus on the clinical
considerations relating to the use of intravenous brivaracetam (IV BRV) for
the treatment of acute seizures in the hospital, focusing on critically ill
patients. Methods This was a scoping literature review of PubMed from inception to April 13,
2021, and search of the American Academy of Neurology (AAN) 2021 Annual
Meeting website for English language publications/conference abstracts
reporting the results of IV BRV use in hospitalized patients, particularly
in the critical care setting. Outcomes of interest relating to the clinical
pharmacology, safety, tolerability, efficacy, and effectiveness of IV BRV
were reviewed and are discussed. Results Twelve studies were included for analysis. One study showed that plasma
concentrations of IV BRV 15 min after the first dose were similar between
patients receiving IV BRV as bolus or infusion. IV BRV was generally well
tolerated in patients with acute seizures in the hospital setting, with a
low incidence of individual TEAEs classified as behavioral disorders. IV BRV
demonstrated efficacy and effectiveness and had a rapid onset, with clinical
and electrophysiological improvement in seizures observed within minutes.
Although outside of the approved label, findings from several studies
suggest that IV BRV reduces seizures and is generally well tolerated in
patients with status epilepticus. Conclusions IV BRV shows effectiveness, and is generally well tolerated in the management
of acute seizures in hospitalized patients where rapid administration is
needed, representing a clinically relevant antiseizure medication for
potential use in the critical care setting.
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Affiliation(s)
- Kiwon Lee
- Department of Neurology, Division of Stroke and Critical Care, Rutgers, The State University of New Jersey, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | | | - Denise H Rhoney
- 15521UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC, USA
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Abdulaziz AT, Sander JW. The increasing challenge of epilepsy in the elderly: shortening hospital admission. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:669-671. [PMID: 33263606 DOI: 10.1590/0004-282x20200190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 10/24/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Ammar T Abdulaziz
- Sichuan University, West China Hospital, Department of Neurology, Chengdu, China.,NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, & Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, & Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
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