Abstracts

Rationale: The recommendations for first drug choice in newly diagnosed epilepsy are inconsistently followed and we sought to examine how non-recommended first anti-seizure medication (ASM) choice may be associated with acute care utilization.

Methods: This was a retrospective cohort study of adults (>18 years) with newly diagnosed epilepsy (identified using validated ICD-CM codes for epilepsy or convulsion) in 2015 to 2016. The participants were sampled from the IBM Marketscan’s Commercial and Medicare Databases (2013-2017). Participants with an epilepsy related code were excluded if they had an ASM prescribed or an epilepsy or convulsion diagnosis in the two years prior or if they had less than 3 years of continuous enrollment. The primary outcome was acute care utilization, defined as an emergency department visit or hospitalization. ASMs were categorized based on the AES/AAN guidelines for the treatment of focal epilepsy: (1) “recommended” (gabapentin, lamotrigine, levetiracetam, zonisamide); (2) “neutral” (brivaracetam, carbamazepine, eslicarbazepine acetate, lacosamide, oxcarbazepine, pregabalin, topiramate, valproic acid); (3) “not recommended” (phenytoin, felbamate, phenobarbital, vigabatrin, rufinamide, cannabidiol, primidone); or (4) “benzodiazepines.” Descriptive statistics were used to quantify and characterize covariates and a negative binomial regression model was conducted adjusting for age, sex, Elixhauser comorbidity index, history of stroke, traumatic brain injury (TBI), brain tumor or dementia (identified at or before the time of epilepsy diagnosis) and ASM polypharmacy to examine the relationship between particular medication choices and acute care utilization. Incidence rate ratios and 95% confidence intervals were estimated. Planned analyses include individually comparing commonly prescribed medications in this cohort and analyses with epilepsy/seizure specific acute care utilization as the outcome.

Results: There were 10,410 people with newly diagnosed epilepsy in 2015-2016 who were prescribed an ASM within 1-year. Mean age was 52 and 52% were females. The three most commonly prescribed medications were levetiracetam (57%), gabapentin (10%), and topiramate (7%). Approximately 60% of people with newly diagnosed epilepsy had an acute care visit, and approximately 9% had an acute care visit for epilepsy or seizure. Table 1 shows factors associated with increased number of acute care visits in this cohort.

Conclusions: Adults with newly diagnosed epilepsy are frequent users of acute care. Initial multivariable model suggests that comorbid disease, including neurologic comorbidity, benzodiazepine prescription and ASM polypharmacy may be drivers of acute care use in this population.

Funding: LJB received support from AES, the Epilepsy Foundation and the Mount Sinai Claude D Pepper Older Americans Independence Center (5P30AG028741-11). NJ is the Bludhorn Professor of International Medicine. LJB and PA are co-first authors.