Vulnerable patients more likely to be prescribed older ASMs

Vulnerable patient groups, including those with dementia or psychiatric conditions and patients aged 85 years and older, are more likely than other patient groups to be prescribed older antiseizure medications (ASMs) following ischaemic stroke.

This is according to a new study by Monash University that involved researchers from the Centre for Medicine Use and Safety (CMUS) following 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.

While there has been a considerable shift towards newer-generation ASMs for poststroke seizures and epilepsy between 2013 and 2017, people over 85 years, with dementia and psychotic comorbidities were less likely to receive newer-generation ASMs as a first-line treatment, according to the study.

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.

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,” Kim said.

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

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.”

Quality Use of Medicines and Medicine Safety is Australia’s 10th National Health Priority Area. The findings have been published in Epilepsia Open and were presented at the International Conference on Pharmacoepidemiology & Therapeutic Risk Management in Halifax, Canada.

Image credit: iStockphoto.com/peakSTOCK