Objective:
To evaluate anti-seizure medication (ASM) usage patterns in patients with epilepsy, comparing men and women over age 55, and assessing differences in ASM utilization in women before and after menopause.
Background:
Postmenopausal women experience hormonal changes that affect seizure thresholds, drug metabolism, and sensitivity, often requiring adjustments in ASM type or dosage, Additionally, studies show the increasing incidence of epilepsy in older age groups, either in the setting of neurodegenerative, structural or metabolic disorders. This population presents unique challenges that influence ASM selection and tolerability. While treatment guidelines exist for women of reproductive age, there is a dearth of studies focused on postmenopausal women.
Design/Methods:
We conducted a retrospective analysis using Epic’s (Electronic Medical Record) data exploration tool, Slicer Dicer. Age 55 was selected as an approximate threshold for menopause. Patients prescribed at least one of 12 commonly used ASMs were included. We compared ASM usage between men and women over 55, and between women under vs above age 55. Differences were assessed using chi-square tests.
Results:
Our analysis included 5,844 women <55 (W<55), 4,266 women >55 (W>55) and 3,854 men above 55 (M>55). ASM distribution was similar between M>55 and W>55. In contrast, marked differences were observed between W<55 vs W>55 respectively: (1) ASMs more prevalent in W<55: Lamotrigine (27.89% vs 16.99%, p<0.001), Clobazam (10.06% vs 2.93%, p<0.001), Oxcarbazepine (6.10% vs 3.16%, p<0.001). (2) ASMs more prevalent in W>55: Levetiracetam (36.24% vs 43.48%, p<0.001) Gabapentin (7.54% vs 13.64%, p<0.001), Carbamazepine (2.53% vs 5.43%, p<0.001).
Conclusions:
Distinct differences in ASM prescribing patterns exist between pre- and postmenopausal women with epilepsy. We aim to expand the current study to the ECAM Consortium centers to validate these patterns across broader population. Future studies examining the drivers and clinical consequences of these differences will inform more tailored prescribing practices for women with epilepsy across the reproductive lifespan.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.