New-generation antiseizure medications are better tolerated for patients with epilepsy

1. Newer-generation antiseizure medications (ASMs) were better tolerated and more likely to be maintained than older ASMs.

2. Only 23% of patients were referred to epilepsy specialists despite high rates of pharmacoresistance.

Evidence Rating Level: 3 (Average)

This study analyzed antiseizure medication (ASM) prescription patterns in 84 patients with post-traumatic epilepsy (PTE) following severe traumatic brain injury (TBI), using data from a prospectively maintained single-center database (2002–2018). PTE was defined as a seizure >7 days post-injury, with ≥6 months follow-up. Patients were categorized by ASM type—older (e.g., phenytoin) vs. newer (e.g., levetiracetam)—and assessed for pharmacoresistance, neurology referral, and functional outcomes via the Glasgow Outcome Scale (GOS). At PTE onset, 53% were on newer ASM monotherapy, 27% on older ASMs, and 20% on polytherapy. Newer ASM monotherapy was more likely to be maintained (OR 4.6, p=0.02), while older ASMs were associated with treatment changes. Despite 54% of patients trialing ≥2 ASMs, only 23% were referred to epilepsy specialists. Pharmacoresistance, present in 32% by 2 years, was predicted by decompressive hemicraniectomy (OR 6.0) and initial polytherapy (OR 7.2), and correlated with worse GOS scores. These findings support newer ASM use, early monotherapy, and timely epilepsy referrals to improve long-term outcomes in PTE.

Click to read the study in Neurology

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