title: Guideline conform initial monotherapy increases in patients with focal epilepsy: A population-based study on German health insurance data.
abstract: OBJECTIVE
  To examine the implementation of the clinical practice guideline "first epileptic seizure and epilepsy in adulthood" published in 2008 to patients with newly diagnosed epilepsy between 2008 and 2014.
  
  
  METHODS
  This retrospective, population-based analysis was performed on patient data of 4.1 million insurants from the German statutory health insurance. Prevalent and incident cases in adults were identified based on ICD-10 codes, using a hierarchical diagnosis selection algorithm. The first anticonvulsive agent in a newly diagnosed epilepsy patient was validated against the clinical practice guideline.
  
  
  RESULTS
  We determined an annual crude prevalence rate in adults between 0.946% and 1.090% and incidence rates of at least 156 per 100,000. A significant increase in guideline compliant monotherapy was found in patients with a focal epilepsy syndrome, while, among patients with idiopathic generalised epilepsies, the share of guideline noncompliant monotherapy increased. Both changes are likely due to the overall increase in prescription of levetiracetam from 19.6% in 2008 to 58.9% in 2014 in all newly treated patients. Overall, the proportion of enzyme-inducing anticonvulsants fell significantly from 20.7% in 2008 to 4.3% in 2014 (p<0.001). The likelihood to receive non-enzyme-inducing antiepileptic drugs was 5.82 (95% CI 4.62-7.33) higher in 2014 than in 2008.
  
  
  CONCLUSIONS
  Initial monotherapy for focal epilepsy is in line with current clinical practice guidelines and mainly implemented by prescription of levetiracetam. Further evaluations should address the question of whether patients treated in line with the guidelines have a favorable outcome, compared to patients not treated in line with current guidelines.
authors.affiliation: Gesundheitsforen Leipzig, Munich, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Ertl
authors.affiliation: Gesundheitsforen Leipzig, Munich, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Hapfelmeier
authors.affiliation: Desitin Arzneimittel GmbH, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Peckmann
authors.affiliation: Desitin Arzneimittel GmbH, Hamburg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Forth
authors.affiliation: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany. Electronic address: strzelczyk@med.uni-frankfurt.de.
authors.forename: Adam
authors.initials: A
authors.lastname: Strzelczyk
mesh_terms: D000927:Anticonvulsants / Q000592:standards* / Q000627:therapeutic use*; D004828:Epilepsies, Partial / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017408:Guidelines as Topic; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D009313:National Health Programs / Q000706:statistics & numerical data; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam
keywords: Clinical practice guideline; Epidemiology; Epilepsy; Seizure