Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy

Natalie N. Rohde, Christine B. Baca, Anne C. Van Cott, Karen L. Parko, Megan E. Amuan, Mary Jo Pugh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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: 33 years; 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 (≤ 45 years). 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). Significance: 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.

Original languageEnglish (US)
Pages (from-to)133-139
Number of pages7
JournalEpilepsy and Behavior
Volume46
DOIs
StatePublished - May 1 2015

Fingerprint

Afghanistan
Drug Prescriptions
Iraq
Veterans
etiracetam
Anticonvulsants
Epilepsy
Comorbidity
zonisamide
Valproic Acid
Psychiatry
Veterans Health
Cerebrovascular Disorders
United States Department of Veterans Affairs
Neurology
Post-Traumatic Stress Disorders
Bipolar Disorder
Headache
Dementia
Seizures

Keywords

  • Afghanistan war veterans
  • Antiepileptic drugs
  • Cohort studies
  • Epilepsy/seizures
  • Iraq war veterans
  • Medical care

ASJC Scopus subject areas

  • Clinical Neurology
  • Behavioral Neuroscience
  • Neurology

Cite this

Rohde, N. N., Baca, C. B., Van Cott, A. C., Parko, K. L., Amuan, M. E., & Pugh, M. J. (2015). Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy. Epilepsy and Behavior, 46, 133-139. https://doi.org/10.1016/j.yebeh.2015.03.027

Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy. / Rohde, Natalie N.; Baca, Christine B.; Van Cott, Anne C.; Parko, Karen L.; Amuan, Megan E.; Pugh, Mary Jo.

In: Epilepsy and Behavior, Vol. 46, 01.05.2015, p. 133-139.

Research output: Contribution to journalArticle

Rohde, Natalie N. ; Baca, Christine B. ; Van Cott, Anne C. ; Parko, Karen L. ; Amuan, Megan E. ; Pugh, Mary Jo. / Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy. In: Epilepsy and Behavior. 2015 ; Vol. 46. pp. 133-139.
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abstract = "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: 33 years; 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 (≤ 45 years). 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). Significance: 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.",
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