Antiseizure Medication Use in Younger and Older Adults with Epilepsy/seizure: A Comparative Analysis from a Large Electronic Health Record Database
Abstract number :
1.43
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2024
Submission ID :
1084
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Xintian Lyu, BS – University of Minnesota
Yuhan Long, BS, BSChE – University of Minnesota
Silvia Illamola, PhD, PharmD – University of Minnesota
Ilo Leppik, MD – University of Minnsota Medical Center
Rebecca O'Dwyer, MD – Rush University Medical Center
Birnbaum Angela, PhD – University of Minnesota
Rationale: Approximately one in four newly diagnosed individuals with epilepsy are older adults. Older adults are biologically and clinically different from younger adults; however, there are no universally accepted treatments. Managing epilepsy in older individuals requires special consideration as they are prone to drug-drug interactions due to co-medications and may require dose adjustments to avoid toxicity. Our objectives are to compare the anti-seizure medications (ASMs) prescription, drug concentration, and co-medications between younger and older epilepsy patients.
Methods: Data were collected from Fairview Health/University of Minnesota Physician electronic health records January 1, 2015, to December 31, 2022. The variables collected included date of birth, sex, race, medical history, ASMs, co-medications, and ASM concentrations. Outpatients who were diagnosed with epilepsy/seizures were included. Patients were stratified into two age groups: younger (18-65 years) and older patients (≥65 years). The number of times of ASM orders/prescriptions per year was determined. The last recorded visit was used to determine the number of ASMs and co-medications per patient. The median and range of levetiracetam (LEV) concentrations for patients were calculated. The Mann-Whitney U Test was used for comparisons between younger and older patients on the last visit (p=0.05). Data analyses were performed using R (v. 4.4.0).
Results: The final dataset included 355,357 patients representing 6,085,350 visits. Epilepsy/seizure was indicated in 29,904 patients, with 19,301 younger and 7,609 older patients. The sex distribution was similar, with 48.1% men and 51.9% women. The racial representation was Caucasian (79.6%), African American (9.3%), Asian (3.1%), Native American (1.5%), other race groups (1.4%), and unknown (5.1%). Younger patients (median 1, range 1-7) received a similar number of ASMs as older patients (median 1, range 1-5). LEV was the most commonly prescribed ASM in both age groups (N=8,952). Of the LEV patients 2,737 (30.6%) had concentrations available with the median LEV concentration being significantly higher in older (27.0 µg/mL) compared to younger patients (22.3 µg/mL) (p< 0.0001). Older patients also received a higher number of comedications compared to younger patients (p< 0.0001).
Anti-seizure Medications