A new study published in Epilepsia found that although most newly diagnosed cases of epilepsy in older adults are treated appropriately with monotherapy, only half of those patients receive treatment within the recommended time frame, and a substantial portion were prescribed older antiepileptic drugs (AEDs) despite recommendations to use newer AEDs in this population.

Investigators from the University of Birmingham in Alabama and Emory University in Atlanta, Georgia, conducted a retrospective analysis of Medicare claims filed in 2009 to assemble a cohort of 3706 probable cases of epilepsy in 3 age categories: 67 to 74 years (34.9%), 75 to 84 years (37.3%), and 85 years and older (27.8%). The majority of patients were female (64.9%) and from the south (49.2%). The original random 5% sample of the Medicare database was racially enhanced (61.2% African American, 18.0% white, 12.3% Hispanic, 6.6% Asian, and 2.0% American Indian/Alaskan Native) to evaluate treatment patterns across minority groups.

The vast majority of the Medicare sample (95%) was given monotherapy in accordance with Quality Indicators for Epilepsy Treatment 6 (QUIET 6) recommendations.2 Divergence from recommendations occurred, however, in the choice of first-line therapy. Although levetiracetam was appropriately chosen for initial monotherapy in 45.5% of the cohort, older, less desirable agents such as phenytoin, divalproex, and carbamazepine were prescribed for 30.6%, 9.5%, and 2.4% of patients, respectively. Gabapentin, which was recommended in previous studies3,4 for older patients because of a more favorable adverse effect profile and reduced interactions with other drugs, was only prescribed to 6.1% of the total Medicare cohort.

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