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Multimorbidity and chronic co-prescription networks and potential interactions in adult patients with epilepsy: MorbiNet study

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Abstract

Objective

We constructed epilepsy multimorbidity networks to study associations with chronic conditions, and co-prescriptions and drug–disease networks to assess potential interactions. We conducted a population-based study in Catalonia, Spain, with electronic files of 3,135,948 adult patients with multimorbidity, 32,625 of them with epilepsy (active diagnosis any time during 2006–2017). We constructed epilepsy comorbidity networks using logistic regression models from odds ratio estimates adjusted by age, sex, and comorbidities with R software and generated trajectories to study the progression of epilepsy. We constructed drug-disease and co-prescription networks using mixed models with repeated measures adjusting by age, sex, and period with chronic prescription invoiced data. Comorbidity more frequently preceding epilepsy included cerebrovascular accident (OR: 3.59), congenital anomalies (2.18), and multiple sclerosis (1.33); and following epilepsy: dementia (1.91), personality disorder (1.59), alcohol abuse (1.22), and Parkinson (1.21). Mental retardation (13.08), neurological cancer (8.49), benign neoplasm (4.69), infections (3.14), and psychosis (1.58) might precede or not epilepsy. A common progression was to schizophrenia, dementia, and other neurological diseases (mainly cerebral palsy and other degenerative diseases of nervous system). Co-prescription associations with major-moderate potential interactions were 54% for carbamazepine, 61% phenytoin, 53% phenobarbital, and 32% valproate. Major potential interactions were with antipsychotic, anxiolytic, opioid, cardiovascular, and other anti-seizure medications (ASMs). The most frequent comorbidities of epilepsy were congenital, cerebrovascular, and neurological and psychiatric conditions. High comorbidity and co-prescription with potential interactions can increase the complexity of care of patients with epilepsy.

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Data availability

The data that support the results of the study are available from SIDIAP. Some restrictions apply to the availability of them. They were released after the signature of a contract and can only be used for the current study, and so they are not publicly available. However, they are available from the authors upon reasonable request and with permission of SIDIAP.

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Funding

The study was funded by Institute of Health Carlos III, and co-funded by The European Regional Development Fund (ERDF) — a way to build Europe — (Grant: PI17/01182, 2017), and Agency for Management of University and Research Grants, AGAUR, of the Catalan Government (Grant: 2017SGR723).

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Authors and Affiliations

  1. Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), Barcelona, Spain

    Ferran Moratalla-Navarro & Victor Moreno

  2. Molecular Mechanisms and Experimental Therapy in Oncology (ONCOBELL) Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain

    Ferran Moratalla-Navarro & Victor Moreno

  3. Biomedical Research Networking Centers (CIBER) of Epidemiology and Public Health (CIBERESP), Madrid, Spain

    Ferran Moratalla-Navarro & Victor Moreno

  4. Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Campus Bellvitge, Barcelona, Spain

    Ferran Moratalla-Navarro & Victor Moreno

  5. Urban Martorell Health Care Area, Catalan Institute of Health, Martorell, Spain

    Flora López-Simarro

  6. SAP Muntanya, Catalan Institute of Health, Barcelona, Spain

    Maria Estrella Barceló

  7. CAP Sagrada Familia, Integral Sanitary Consortium, Barcelona, Spain

    Alba Aguado

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  1. Ferran Moratalla-Navarro
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  4. Maria Estrella Barceló
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  5. Alba Aguado
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Contributions

A.A. and V.M. designed the study. F.M.N. prepared the database, performed the statistical analysis, and constructed the networks and website. V.M. coordinated the analysis, networks, and website. A.A., F.M.N., F.L.S., M.E.B., and V.M. analyzed the results. A.A., M.E.B., and F.L.S. wrote and edited the manuscript. All authors provided critical review and approved the manuscript.

Corresponding author

Correspondence to Alba Aguado.

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Ethics approval

The study was approved by the Integral Sanitary Consortium Ethics Committee (16/457) and IDIAP Jordi Gol Ethics Committee (P17/207). It was performed in accordance with the standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to participate and publication

We could not obtain written informed consent from patients to use clinical data because the study is population-based and observational retrospective. Consent was waived thy the Ethics Committes. Data was anonymized and did not contain variables that might identify individual patients. The study was conducted according to the Spanish law on the protection of personal data and the guarantee of digital rights (Organic Law 3/2018 of December 5), and Regulation of the European Parliament and Council on the protection of people (EU 2016/679 of April 27).

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The authors declare no competing interests.

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Moratalla-Navarro, F., Moreno, V., López-Simarro, F. et al. Multimorbidity and chronic co-prescription networks and potential interactions in adult patients with epilepsy: MorbiNet study. Neurol Sci 43, 6889–6899 (2022). https://doi.org/10.1007/s10072-022-06375-3

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