May 30, 2023

Does ASM Polypharmacy Impact Injury Risk Among Older Adults With Epilepsy? 

Article published by Neurology Advisor


Most older adults with seizures receive an appropriate first prescription for antiseizure medication (ASM), and the risk for injury is associated with ASM polypharmacy. These are the findings of a retrospective cohort study published in Seizure: European Journal of Epilepsy. 


The prevalence of seizures roughly doubles between the ages of 50 and 80 years. More than 95% of patients with epilepsy are treated with ASMs as they are effective at preventing recurrent seizures; however, older adults may be vulnerable to the side effects of ASMs. 


Researchers from Icahn School of Medicine at Mount Sinai in the United States sourced data for this study from the MarketScan’s Commercial and Medicare Database. Adults (N=5,931) aged 50 years and older with newly diagnosed epilepsy or convulsion between 2015 and 2016, who received a minimum 30-day supply of ASMs within 1-year of diagnosis, were evaluated for injury within 1-year of ASM prescription. 


The exposure of interest was whether patients received guideline recommended (eg, gabapentin, lamotrigine, levetiracetam, zonisamide), neutral (brivaracetam, carbamazepine, eslicarbazepine acetate, pregabalin, lacosamide, oxcarbazepine, topiramate, valproic acid), not recommended (cannabidiol, felbamate, phenobarbital, phenytoin, primidone, rufinamide, vigabatrin), or benzodiazepine ASMs. 


Efforts to improve prescribing in older adults with epilepsy should consider both avoidance of potentially inappropriate therapies as well as avoidance of polytherapy.