Trends in antiseizure medication use among women of childbearing age with epilepsy.

BACKGROUND

Women of childbearing age (WOCBA) with epilepsy who have significant adverse events or fail to achieve seizure freedom with first- and second-generation antiseizure medications (ASMs) may be switched to third-generation ASMs, although data regarding their teratogenicity are limited and dose dependency is currently unknown.

OBJECTIVE

To identify patterns of ASM use among WOCBA with epilepsy.

METHODS

We retrospectively reviewed the medical records of all the WOCBA with ASM-treated epilepsy who had their first visit in our outpatient epilepsy clinic during a 13-year period (2012-2024).

RESULTS

The study group included 341 women, 53% with focal epilepsy, 69% treated with ASM monotherapy. During the study period, there was an increase in the use of third-generation ASMs (p = 0.047), specifically brivaracetam (p = 0.046), an increase in the use of second-generation ASMs (p = 0.135), significant for levetiracetam (p = 0.0001), and a significant decrease in the use of first-generation ASMs (p = 0.0001), especially phenytoin (p = 0.001) and carbamazepine (p = 0.031). The mean prescribed daily dose was >200 mg for brivaracetam and > 300 mg for lacosamide.

CONCLUSIONS

These findings indicate a shift in ASM treatment patterns among WOCBA over the past 13 years. Despite recommendations to restrict the use of third-generation ASMs in this population due to insufficient data regarding teratogenicity, the mean daily doses of lacosamide and especially brivaracetam were relatively high. These results highlight the need for further research to explore possible dose-related teratogenicity for individual third-generation ASMs.