Older patients more likely to be prescribed outdated antiseizure medications

Stroke is a major cause of disability and death worldwide but there is no robust data on the optimal management of poststroke seizures and epilepsy. [Source: Shutterstock]

Key points:

Compared to the general population, people who experience a stroke are at higher risk of developing epilepsy
An ischemic stroke occurs when a vessel supplying blood to the brain is obstructed
Experts say older antiseizure medications can lead to side-effects and interactions, which may be harmful to those who are vulnerable to health-related issues

In the event of an ischemic stroke, older patients have been found to be prescribed older antiseizure medications, leaving them open to adverse reactions.

A new study from Monash University has found the vulnerable group – including those with dementia, psychiatric conditions and patients aged 85 years and older – are more likely than other patient groups to be dispensed older antiseizure medications following ischaemic stroke.

Antiseizure medications are the main treatment option for controlling seizures after stroke and while there was an overall trend toward the dispensing of newer antiseizure medications over time, it was older people being prescribed older medications. People living in rural areas were less likely to receive the newer medication compared to metropolitan areas.

The team of researchers from the Centre for Medicine Use and Safety (CMUS) at the Monash Institute of Pharmaceutical Sciences followed 19,601 people hospitalised with a first ischaemic stroke in Victoria from 2013-2017. Of these people, 989 were dispensed antiseizure medication within 12 months of hospital discharge.

Compared to the general population, people who experience a stroke are at higher risk of developing epilepsy, which is a common and serious neurological disorder characterised by recurrent unprovoked seizures.

Senior author Dr Jenni Ilomaki said, “Older antiseizure medications are often associated with side-effects and interactions, and it’s concerning these medications were dispensed to vulnerable patient groups arguably at greatest risk of medication-related harm.”

“Our hope is the findings from this study will pave the way for further investigation into the effectiveness and safety of different antiseizure medications in Australia’s most vulnerable groups.”

CMUS PhD candidate Stella Kim said those aged 60 years and older run a higher risk of developing newly diagnosed epilepsy after stroke, and therefore optimal medication treatment plans are crucial.

“Antiseizure medications are the main treatment option for controlling seizures after stroke, and treatment should be individualised according to factors such as seizure type, demographic factors, comorbidities and concurrent medications,” she said.

“Our study highlights the need for further research into the comparative safety and effectiveness of antiseizure medications.”

The study suggested a factor contributing to the use of newer or older medications could be attributed to the density of medical specialists and physician preference.

Similar studies conducted in Sweden and the United States found that patients were more likely to be prescribed newer medications from neurologists compared to other specialists like General Practitioners (GPs). The uneven distribution of neurologists between metropolitan and regional Victoria could have accounted for different treatment preferences and since there are no Australian clinical practice guidelines on poststroke seizures, physicians may prefer to choose medications with a longer history of proven benefits.

The findings have been published in Epilepsia Open and were presented at the International Conference on Pharmacoepidemiology & Therapeutic Risk Management in Halifax Canada.