Optimizing Initial Seizure Treatment in Older Adults: A Retrospective Cohort Study in Medicare Linked to the Health and Retirement Study
Abstract number :
2.072
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2025
Submission ID :
1131
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Leah Blank, MD, MPH – Icahn School of Medicine at Mount Sinai, New York
Rachelle Morganstern, MPH – Icahn School of Medicine at Mount Sinai
Kenneth Boockvar, MD – University of Alabama at Birmingham
Katherine Ornstein, PhD, MPH – Johns Hopkins
Madhu Mazumdar, PhD – Icahn School of Medicine at Mount Sinai
Georges Naasan, MD – Icahn School of Medicine at Mount Sinai
Colleen Maxwell, PhD – University of Waterloo
Nihal Mohamed, PhD – Icahn School of Medicine at Mount Sinai
Nathalie Jette, MSc, MD, FRCPC – Alberta Health Services, Cumming School of Medicine, University of Calgary
Rationale: The growing population of older adults faces a high risk of developing epilepsy. We aimed to understand current anti-seizure medication (ASM) use including choice of initial ASM and length of ASM use in this demographic to inform age-appropriate ASM selection and management strategies.
Methods: This retrospective cohort study analyzed Medicare claims data (2006-2020) linked to the Health and Retirement Study (HRS) to investigate ASM use and persistence in adults over age 50. We used a validated case definition for epilepsy which includes a new seizure or epilepsy diagnosis (ICD-9: 345.x or 780.3 or ICD-10: G40.x or R56.x) and a new prescription of an ASM. To focus on newly diagnoses epilepsy, we excluded those with prior diagnoses of seizure or epilepsy or ASM use within a specific look-back period of 2 years. Persistence of the initial ASM for the 5 most common agents, as defined by a gap of 60 days or more, or the prescription of a new ASM was examined with Kaplan-Meier survival plots.
Results: Of the 341 older adults newly diagnosed with seizures and started on ASM, the mean age was 74.7 years (standard deviation 11.2 years). The cohort was largely female (65.7%) and predominantly non-Hispanic white (67.2% ), followed by Black individuals (26.7%). The five most commonly prescribed ASMs were: levetiracetam (27%), lorazepam (15%), phenytoin (12.6%), gabapentin (11.4%) and pregabalin (9.9%). Over the full follow-up time, a significant majority, 78% of patients discontinued the initial ASM prescribed. Patients remained on levetiracetam and gabapentin longer than the other most commonly prescribed ASMs (see Figure 1).
Conclusions: When epilepsy is diagnosed in older adults, they are often prescribed ASMs that have known adverse effects as initial therapy for epilepsy. However, ASMs recommended by the American Epilepsy Society and American Academy of Neurology guidelines for initial therapy are associated with longer persistence, which may suggest they are more effective or cause fewer side effects.
Funding: This work was supported by the National Institute on Aging ( K23AG080163).
Health Services (Delivery of Care, Access to Care, Health Care Models)