Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy.
OBJECTIVE
We examined patterns of antiepileptic drug (AED) use in a cohort of Iraq/Afghanistan war veterans (IAVs) who were previously identified as having epilepsy. We 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.


METHODS
From the cohort of IAVs previously identified with epilepsy between fiscal years 2009 and 2010, we selected those who received AEDs from the Veterans Health Administration in FY2010. Regimens were classified as monotherapy or polytherapy, and specific AED use was examine overall and by gender. Multivariable logistic regression examined associations of age; gender; race/ethnicity; medical, psychiatric, and neurological comorbidities; and receipt of neurology specialty care associated with the six most commonly used AEDs.


RESULTS
Among 256,284 IAVs, 2123 met inclusion criteria (mean age: 33years; 89% men). Seventy-two percent (n=1526) received monotherapy, most commonly valproate (N=425) and levetiracetam (n=347). Sixty-one percent of those on monotherapy received a newer AED (levetiracetam, topiramate, lamotrigine, zonisamide, oxcarbazepine). Although fewer women than men received valproate, nearly 90% (N=45) were of reproductive age (≤45years). Antiepileptic drug prescribing patterns were associated with posttraumatic stress disorder, bipolar disorder, cerebrovascular disease, dementia/cognitive impairment, headache, and receipt of neurological specialty care (all p<0.01).


CONCLUSIONS
In this cohort of veterans with epilepsy, most received AED monotherapy and newer AEDs. Prescribing patterns were different for men and women. The patterns observed between AEDs and neurological/psychiatric comorbidities suggest that clinicians are practicing rational prescribing.
VA Epilepsy Centers of Excellence, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA; Department of Epidemiology and Biostatistics, UTHSCSA, San Antonio, TX, USA. Electronic address: Natalie.Rohde@VA.gov.
Natalie N
NN
Rohde
VA Epilepsy Center of Excellence, VAGLAHS, Los Angeles, CA, USA; Department of Neurology, UCLA, 710 Westwood Plaza, Los Angeles, CA 90095, USA. Electronic address: CBower@mednet.ucla.edu.
Christine B
CB
Baca
VA Pittsburgh Healthcare System, University of Pittsburgh, University Drive C, Pittsburgh, PA 15240, USA; Department of Neurology, University of Pittsburgh, PA, USA. Electronic address: Anne.VanCott@va.gov.
Anne C
AC
Van Cott
VA Epilepsy Centers of Excellence, San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Neurology, University of California, San Francisco, San Francisco, CA, USA. Electronic address: karen.parko@ucsf.edu.
Karen L
KL
Parko
Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA; Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, 200 Springs Road (152), Bedford, MA 01730, USA. Electronic address: megan.amuan@va.gov.
Megan E
ME
Amuan
VA Epilepsy Centers of Excellence, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA; Department of Epidemiology and Biostatistics, UTHSCSA, San Antonio, TX, USA; Texas A&M Health Science Center, Department of Medicine, Bryan, TX, USA. Electronic address: MaryJo.Pugh2@VA.gov.
Mary Jo
MJ
Pugh
D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
D000927:Anticonvulsants
Afghanistan war veterans; Antiepileptic drugs; Cohort studies; Epilepsy/seizures; Iraq war veterans; Medical care