Trends in Antiepileptic Drug Use in Pharmacoresistant Epilepsy

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Abstract

Background: Antiepileptic drugs are the cornerstone of treatment in patients with epilepsy.

AIM: to examine the spectrum of antiepileptic drugs across different generations and trends in their use over the 20th and 21st centuries.

MATERIALS AND METHODS: A retrospective observational cohort study was conducted in 2022–2024. Study population: patients with a verified diagnosis of epilepsy. Study focus: antiepileptic drug therapy. Patients with a verified diagnosis of epilepsy were divided into 2 groups: group 1 included patients from the 20th century with epilepsy duration of more than 20 years as of 2020; group 2 included patients from the 21st century with epilepsy duration of less than 20 years. The history of antiepileptic drugs use was evaluated by generation: first-generation (traditional/older), second-generation (newer), and third-generation (most recent). The frequency of first-generation antiepileptic drugs use was calculated both as a percentage and as the mean number of antiepileptic drugs per patient for the 20th and 21st centuries.

RESULTS: The study included 60 patients: group 1 comprised 28 patients and group 2, 32 patients. The mean age and disease duration in the overall cohort were 31.5±9.3 years and 19.5±9.1 years, respectively; the male-to-female ratio was 1:1. The mean number of antiepileptic drugs used per patient over time was 5.1±2.3 (range, 2–10). First-generation antiepileptic drugs were used in 61% of patients in group 1 and 42% in group 2; second-generation in 32% and 46%, respectively; and third-generation in 7% and 12%, respectively. The mean number of first-generation antiepileptic drugs per patient across the cohort was 2.2±1.5, with group-specific means of 3.1 in group 1 and 1.3 in group 2. Barbiturates accounted for 24% of prescriptions in group 1 and 5% in group 2; benzodiazepines, for 5% and 0%, respectively; valproates, for 26% in both groups; and carbamazepine, for 13% and 8%, respectively.

CONCLUSION: An increased use of newer-generation antiepileptic drugs (anticonvulsants) was observed in the 21st century, with a marked decline in older-generation drugs, primarily due to decreased use of barbiturates and benzodiazepines. Valproic acid and carbamazepine have maintained their roles in epilepsy management.

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About the authors

Galina V. Odintsova

A.L. Polenov Russian Research Neurosurgical Institute is the branch of the Federal State Budgetary Institution “V.A. Almazov National Medical Research Center” of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: odintsova_gv@almazovcentre.ru
ORCID iD: 0000-0002-7186-0054
SPIN-code: 1303-4651

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Nina O. Dengina

A.L. Polenov Russian Research Neurosurgical Institute is the branch of the Federal State Budgetary Institution “V.A. Almazov National Medical Research Center” of the Ministry of Health of the Russian Federation

Email: dengina_no@almazovcentre.ru
ORCID iD: 0000-0003-2667-7717
SPIN-code: 4005-6506

MD, Cand. Sci. (Pedagogical), Associate Professor

Russian Federation, Saint Petersburg

Natalia E. Ivanova

A.L. Polenov Russian Research Neurosurgical Institute is the branch of the Federal State Budgetary Institution “V.A. Almazov National Medical Research Center” of the Ministry of Health of the Russian Federation

Email: ivamel@yandex.ru
ORCID iD: 0000-0003-2790-0191
SPIN-code: 1854-7827

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

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2. Fig. 1. Three generations of antiepileptic drugs for the treatment of epilepsy. Löscher W, Potschka H, Sisodiya SM, Vezzani A. Drug resistance in epilepsy: clinical impact, potential mechanisms, and new innovative treatment options. Pharmacol Rev. 2020;72:606–638. * Not registered in Russia

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3. Fig. 2. Trends in first-generation antiepileptic drug use across the groups.

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4. Fig. 3. Trends in antiepileptic drug use by generation across the groups.

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