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U study shows discrepancy in epilepsy drug prescription

A new University study found antiepileptic drugs are being prescribed to more than 10 percent of nursing home residents, while only 5 percent to 6 percent of residents actually suffer from epilepsy.

The study results are significant because antiepileptic drugs are expensive, can be hard to prescribe correctly and include potential side effects.

While most study subjects were being treated for epilepsy with antiepileptic drugs upon entry into a nursing home, many others were put on antiepileptic drugs within three months of admission. To examine the problem more closely, researchers were recently awarded an additional grant.

The study’s lead author, Judith Garrard, a University health services researcher, said the results of the study are not a cause for alarm; they just indicate a need for more knowledge about the use of antiepileptic drugs.

“It isn’t a matter of misuse or inappropriate use. It’s more a matter of, ‘here’s a very powerful set of drugs, and we need to find out who’s taking them and why are they taking them,’ ” Garrard said.

Ilo Leppik, a University pharmacy professor and study researcher, said epilepsy is more prevalent among those more than 65 years old, not children and infants, as popularly believed.

The study included more than 10,000 residents at 500 nursing homes across the country. Of those patients taking antiepileptic drugs prior to admission, 60 percent were taking them for epilepsy.

Conversely, of those prescribed antiepileptic drugs after admission, approximately 20 percent were prescribed them for treatment of epilepsy. Besides epilepsy, the drugs can also be used to treat some types of depression, pain or symptoms of dementia.

Leppik said the increase in antiepileptic drug prescriptions within the first three months was surprising and the key issue that won them the new grant.

“We’re going to try to answer the question, ‘Why should they start having seizures in a nursing home?’ ” Leppik said.

Researchers will try to determine if the seizures are the result of a stroke, the onset of Alzheimer’s disease or some other condition, he said.

“This is all stuff that we need to look at in more detail,” Leppik said.

Another area the researchers will look at in future studies, Leppik said, is the size of antiepileptic drug doses, often not adjusted for the patient’s age.

Elderly patients require smaller doses, and larger-than-necessary doses cost more and might harm patient health, he said.

“The doses, in many instances, are higher than I would personally be comfortable with,” Leppik said.

Leppik said side effects of antiepileptic drugs can include “dizziness and sedation,” confusion or poor coordination.

The side effects were concerning because the dizziness or sedation that might result from antiepileptic drug use could make the patient harder to care for or more prone to injury, Leppik said.

That could also translate into greater overall health care costs, he said.

Stephan Tradewell, director of the Advocacy Center, a Minnesota nonprofit that fields concerns from consumers about long-term care, said he had not received any complaints about the prescription of antiepileptic drugs. Neither had Sue Jackson, assistant director of the Minnesota Health Department’s Office of Health Facility Complaints.

Dylan Thomas welcomes comments at [email protected]

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