Demographic and Comorbidity Barriers to Therapy Revision in Epilepsy: A Population-Wide Investigation.

BACKGROUND: The first antiseizure medication (ASM) fails due to side effects or continued seizures in about half of cases. We used population-wide register data to assess whether patient demographics or comorbidities influenced likelihood of therapy revision in order to identify gaps in access to adequate epilepsy follow-up. METHODS: National registers identified all adults in Sweden with incident epilepsy between 2007 and 2019 and initial ASM monotherapy based on prescription data. Therapy revision was defined as changing medication or starting a second ASM. Cox proportional hazard models were used to evaluate clinical factors associated with therapy revision. Sensitivity analyses were restricted to patients surviving for 2 or 4 years, or to specific first monotherapies. RESULTS: The final cohort included 44,185 individuals. Age (HR = 0.993, 95% CI: 0.992-0.993), cerebrovascular disease (HR = 0.81, 95% CI: 0.78-0.85), and dementia (HR = 0.63, 95% CI: 0.58-0.69) were associated with reduced likelihood of revising the first ASM. Women (HR = 1.14, 95% CI: 1.10-1.19), patients with brain infections (HR = 1.21, 95% CI: 1.08-1.35), and patients with brain tumors (HR = 1.31, 95% CI: 1.23-1.39) were more likely to revise their first treatment. DISCUSSION: Older persons with epilepsy and those with cerebrovascular disease or dementia are less likely to change the first ASM, suggesting a disadvantage for older persons with epilepsy and those with brain morbidities associated with aging in current health care systems.