RESUMEN
OBJECTIVE: To evaluate the effectiveness and tolerability of brivaracetam (BRV) in a refractory epilepsy population in an outpatient clinical setting. METHODS: Retrospective medical information system review and self-report questionnaire for all patients treated with BRV until the end of 2017. RESULTS: Thirty-eight patients were included, 73.7% female and mean age 36.2. The mean number of antiepileptic drugs (AEDs) for previous use was 8.9, and for current use was 2.5. Mean seizure frequency in the last 3 months was 12 per month. At 3, 6, 12, and 15 months, the 50% responder rates were 36.1%, 32%, 41.2%, and 45.5%, respectively. Patients took BRV for a median duration of 8.25 months, ranging from 7 days to 60 months. Retention rate was 75.0%, 72.0%, 59.2%, and 47.9% at 3, 6, 12, and 15 months, respectively. Overall, the main reasons for discontinuation were adverse events (AEs) (52.3%), lack of efficacy (35.3%), or both (11.8%). The rate of total AEs was 60.5% according to medical records and 85.7% according to questionnaire, including mostly tiredness, psychiatric, and memory complaints. Psychiatric side effects occurred in 31.6% according to medical records and 47.4% according to questionnaire results, which is higher than previously reported and persisted throughout the study period. CONCLUSIONS: BRV appears to be a useful and safe add-on treatment, even in a very refractory group of patients. In this real-life clinical setting, psychiatric AEs were found at a higher rate than previously published.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Epilepsia Refractaria/tratamiento farmacológico , Epilepsias Parciales/tratamiento farmacológico , Epilepsia Generalizada/tratamiento farmacológico , Pirrolidinonas/uso terapéutico , Adulto , Ira , Ansiedad/inducido químicamente , Canadá , Despersonalización/inducido químicamente , Depresión/inducido químicamente , Mareo/inducido químicamente , Quimioterapia Combinada , Regulación Emocional , Femenino , Humanos , Genio Irritable , Masculino , Trastornos de la Memoria/inducido químicamente , Persona de Mediana Edad , Trastornos Paranoides/inducido químicamente , Parestesia/inducido químicamente , Prurito/inducido químicamente , Estudios Retrospectivos , Somnolencia , Resultado del Tratamiento , Adulto JovenRESUMEN
Emergency contraception (EC) can prevent pregnancy after sex, but only if taken within 72 hours of intercourse. Over the past 15 years, access to EC has been expanded at both the state and federal level. This paper studies the impact of those policies. We find that expanded access to EC has had no statistically significant effect on birth or abortion rates. Expansions of access, however, have changed the venue in which the drug is obtained, shifting its provision from hospital emergency departments to pharmacies. We find evidence that this shift may have led to a decrease in reports of sexual assault.