Prescribing of AEDs to New Veterans Deemed ‘Rational’

by U.S. Medicine

August 9, 2015

SAN ANTONIO — VA clinicians got a positive review for their prescribing of antiepileptic drugs (AEDs) in a cohort of Iraq/Afghanistan war veterans.

“The patterns observed between AEDs and neurological/psychiatric comorbidities suggest that clinicians are practicing rational prescribing,” concluded the study team led by researchers from the VA Epilepsy Centers of Excellence at the South Texas Veterans Health Care System.

The report was published recently in the journal Epilepsy & Behavior.1

Examining patterns of AED use in a cohort of Iraq/Afghanistan war veterans (IAVs) who were previously identified as having epilepsy, the authors hypothesized that clinicians would be more likely to prescribe newer AEDs and would select specific AEDs to treat seizures based on patient characteristics including gender and comorbidities.

Looking at all of the veterans from those wars previously identified with epilepsy between fiscal years 2009 and 2010, the study team selected those who received AEDs from the VHA in fiscal year 2010. The drug regimens were classified as monotherapy or polytherapy, and specific AED use was examine overall and by gender.

Results indicate that, among 256,284 IAVs, 2,123 met inclusion criteria; participants averaged 33 years old, and 89% were male.

Of those, 72% received monotherapy, most commonly valproate and levetiracetam, with 61% of those on monotherapy receiving a newer AED such as levetiracetam, topiramate, lamotrigine, zonisamide or oxcarbazepine.

While fewer women than men in the study group received valproate, nearly 90% of them were of reproductive age, defined as 45 or younger.

“Antiepileptic drug prescribing patterns were associated with post-traumatic stress disorder, bipolar disorder, cerebrovascular disease, dementia/cognitive impairment, headache, and receipt of neurological specialty care,” the authors noted, adding, “In this cohort of veterans with epilepsy, most received AED monotherapy and newer AEDs.”

1 Rohde NN, Baca CB, Van Cott AC, Parko KL, Amuan ME, Pugh MJ. Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy. Epilepsy Behav. 2015 May;46:133-9. doi: 10.1016/j.yebeh.2015.03.027. Epub 2015 Apr 21. PubMed PMID: 25911209.

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