Polypharmacy among adolescents and adults with cerebral palsy in a clinical setting

Abstract

Background: Adolescents and adults with cerebral palsy often experience multimorbidity related to their condition, which primarily affects movement and posture but is also associated with pain, epilepsy, mood disorders, and other conditions. As such, these patients are often prescribed a range of medications to manage symptoms, thereby putting them at risk for polypharmacy.

Objectives: To determine the proportion of adolescent and adult patients with cerebral palsy experiencing polypharmacy in a clinical setting and to identify patient factors associated with polypharmacy.

Design and setting: This cross-sectional study involved a retrospective review of medical records from initial visits at the Transitional and Lifelong Care (TLC) program, a specialized outpatient service for adolescents and adults with childhood onset disabilities at a rehabilitation hospital in London, Ontario, Canada.

Participants: All patients with a formal diagnosis of cerebral palsy who had an initial visit with the TLC program between October 2014 and December 2017 (n = 307).

Interventions: Not applicable.

Main outcome measures: Based on the number of regularly scheduled medications recorded, patients taking ≥5 medications were identified as experiencing polypharmacy.

Results: Within the sample of 304 patients, 101 (33.2%) were experiencing polypharmacy (average: 7.9 ± 2.9 medications). Modified Poisson regression models were used to estimate the adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) for the association between patient factors and polypharmacy. Older age (aPR: 2.12; 95% CI: 1.19-3.77), higher Gross Motor Function Classification System (GMFCS) level (aPR: 1.59; 95% CI: 1.02-2.48), and epilepsy history (aPR: 1.64; 95% CI: 1.13-2.38) were associated with experiencing polypharmacy.

Conclusion: Polypharmacy is a common phenomenon among adolescent and adult patients with cerebral palsy in a clinical setting.