title: Choice of the first anti-epileptic drug in elderly patients with newly diagnosed epilepsy: A Finnish retrospective study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, University of Eastern Finland, Kuopio, Finland; University of Oulu, Oulu, Finland. Electronic address: emmi.bruun@student.oulu.fi.
authors.forename: Emmi
authors.initials: E
authors.lastname: Bruun
authors.affiliation: Research Department, Social Insurance Institution of Finland, Turku, Finland.
authors.forename: Lauri J
authors.initials: LJ
authors.lastname: Virta
authors.affiliation: NeuroCenter, Kuopio University Hospital, Kuopio, Finland; Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Reetta
authors.initials: R
authors.lastname: Kälviäinen
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland; Science Service Center, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Tapani
authors.initials: T
authors.lastname: Keränen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use*; D015897:Comorbidity; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Anti-epileptic drug; Drug prescriptions; Elderly; Newly diagnosed epilepsy