Abstracts

Rationale: One of the quality improvement goals of Epilepsy Centers of Excellence (ECoE) in the Veterans Health Administration (VHA) is to evaluate trends of prescribed antiseizure medications (ASMs) with the aim of providing guidance for appropriate treatment.


We identified prescribing trends of ASMs in the VHA for Veterans with epilepsy by analyzing Fiscal Years (FY) 2014, 2018 and 2022 data.




Methods: Veterans with epilepsy (VWE) were defined as those prescribed an ASM for ≥30 days during the FYs, active seizure status on the problem list, and a documented seizure diagnosis. Demographic information collected included age, gender, ethnicity, race and rurality. ASMs were divided into generation I, II and III categories. Percentage were tabulated for categorical demographic variables, ASMs prescribed and for ASM generation categories. Averages of the age variable per FY were computed along with standard deviations. To assess the trends of ASMs prescribed and ASM generations, odds ratios (OR) were computed using simple binary logistic regression models with respective ASM or generation as a dependent binary variable and time as a predictor variable. For statistical significance, the error rate (alpha=0.05) was used.

Results: The counts of VWE identified in FY14, FY18 and FY22 were 60,609, 54,855 and 53,318, respectively. Ages were 62.2±14.6 years in FY2014 and 64.1± 15.1 years in FY2022. The percentage of male population decreased between FY2014 and FY2022 from 92.9% to 90.4%. White comprised approximately 70% and Black 20% in all three index years. There was an increase in the Hispanic/Latino population, 4.8% in FY2014 and 5.7% in FY2022. Urban population increased over the years from 61.2% in FY2014 to 65.8% in FY2022. The analysis of ASM demonstrated levetiracetam as the most commonly prescribed ASM during the three index years (38.3%, 47.9%, 52.3%, respectively). Other ASM included lamotrigine (13.8%, 15.6%, 16.4%), valproate sodium (15.4%, 14.5%, 13.6%) and phenytoin (28.6%, 18.2%, 11.3%). Generation I ASM use decreased from 56.2% in FY2014 to 34.3% in FY2022, whereas Generation II (57%, 68.3% and 73.8%) and III (4.1%, 8.8%, 12.7%) prescriptions increased over time. Logistic regression showed statistically significant increase for levetiracetam (OR=1.07), lacosamide (OR=1.18), lamotrigine (OR=1.02), and oxcarbazepine (OR=1.09). A significant decrease was observed for phenytoin (OR=0.87) and phenobarbital (OR=0.92). No significant change was observed for topiramate. Generation 1 ASMs showed a significant decrease (OR=0.89), and prescription of Generation II (OR= 1.10) and III (1.16) went up significantly.

Conclusions: Data analysis suggests a transition towards prescribing newer ASMs. With the increase in number of female Veterans and the risk of teratogenesis with valproate, phenytoin and topiramate ECoE sites are playing an important role in educating patients and guiding the optimal treatment factoring in gender, epilepsy syndrome and age to improve patient care outcomes.


Funding: No funding received.