Rationale:
This study aims to evaluate the efficacy and side effects of five newer anti-seizure medications (ASMs): Perampanel (PER), Brivaracetam (BRV), Lacosamide (LCM), Eslicarbazepine Acetate (ESL), and Clobazam (CLB) in veterans diagnosed with epilepsy. The focus was on psychiatric and cognitive side effects, as the veteran population is predisposed to higher rates of psychiatric disorders such as PTSD and cognitive impairment. The retrospective analysis included 8,165 veterans with epilepsy across the VA system.
Methods:
In a retrospective analysis, researchers collaborated with the Veterans Affairs (VA) Office to analyze the neurology notes of 8,165 veterans diagnosed with epilepsy using ICD-10 codes. The study focused on consecutive veterans diagnosed across the VA system between January 1, 2011, and June 30, 2022. Adverse events were evaluated, and only veterans prescribed BRV, ESL, LCM, PER, and CLB were included in the analysis. These medications were chosen as they are the most recently approved ASMs in the VA system. Out of the 32 adverse effects tracked, irritability, aggression, nervousness, depression, and psychosis were selected to reflect psychiatric adverse effects, while drowsiness, cognitive impairment, and concentration were chosen to reflect cognitive adverse effects.
Results:
Among the 8,165 patients included in the analysis, the prescription distribution was as follows: 284 patients received BRV, 443 patients received CLB, 155 patients received ESL, 2,787 patients received LCM, and 134 patients received PER. The reported rates of psychiatric adverse effects and cognitive adverse effects for each medication were as follows:
BRV: 13.73% of patients reported psychiatric adverse effects, and 5.63% reported cognitive adverse effects.
CLB: 2.93% of patients reported psychiatric adverse effects, and 6.09% reported cognitive adverse effects.
ESL: 2.58% of patients reported psychiatric adverse effects, and 3.87% reported cognitive adverse effects.
LCM: 1.36% of patients reported psychiatric adverse effects, and 2.05% reported cognitive adverse effects.
PER: 11.19% of patients reported psychiatric adverse effects, and 5.22% reported cognitive adverse effects.
These findings provide insight into the rates of psychiatric and cognitive adverse effects associated with each medication in the veteran population with epilepsy.
Conclusions:
The study's findings suggest that clinicians should exercise caution when prescribing PER and BRV to veterans with epilepsy due to the observed psychiatric and cognitive adverse effects. The increased rates of gun ownership, post-traumatic stress disorder (PTSD), and other psychiatric disorders within this population further emphasize the need for careful consideration. Future research should aim to control for pre-existing comorbidities and explore the effects of multiple anti-seizure medication trials, which will provide valuable insights into optimizing treatment strategies for veterans with epilepsy. By addressing these factors, healthcare professionals can better ensure the well-being and safety of their veteran patients.
Funding: None