Choice of the first anti-epileptic drug in elderly patients with newly diagnosed epilepsy: A Finnish retrospective study

PURPOSE The choice of initial anti-epileptic drug (AED) for elderly and younger adult patients with newly diagnosed epilepsy was assessed. METHODS The pattern of initial prescription of AEDs between 2000 and 2013 was retrospectively studied in two community-dwelling cohorts, identified from the case records of Kuopio University Hospital (KUH): elderly subjects (aged 65 or above at the time of diagnosis; n = 529) and a random sample of younger adults (16-64 years old at the time of diagnosis; n = 201). Furthermore, nationwide register data from the Social Insurance Institution of Finland were included in the analysis, from the years 2004 and 2012. RESULTS Valproic acid (VPA) and carbamazepine (CBZ) were the most common initial AEDs both among the elderly (49% and 31% of prescriptions, respectively) and for the patients in the younger-adults group (19% and 61%, respectively) in the KUH data. In the nationwide register data, the most frequently used initial AEDs for the elderly were VPA and oxcarbazepine. The selection of VPA was associated with higher age (P < 0.001), myocardial infarction (P = 0.003), and stroke (P = 0.013). Lower probability of receiving CBZ was observed with more advanced age (P < 0.001) and myocardial infarction (P = 0.002), whereas diabetes (P = 0.018) and atrial fibrillation (P = 0.045) predicted a higher probability. CONCLUSION First-generation AEDs are still the most commonly employed first drugs for elderly patients with newly diagnosed epilepsy in Finland. Age and comorbid conditions have an effect in the choice of the initial AED treatment.