Trends, prescribing patterns, and determinants of initial antiepileptic drug treatment in older epileptic patients.

This study focuses on the trends, prescribing patterns, and determinants of initial antiepileptic drug (AED) treatment in older Thai patients (aged ≥60 years) with newly diagnosed epilepsy at a tertiary-care hospital from 2012 to 2022. Findings reveal a significant increase in the use of new-generation AEDs—from 10.84% to 35.72%—and a corresponding decline in old-generation AEDs, with monotherapy being the predominant treatment approach. Factors positively associated with initiating new-generation AEDs include later treatment year, non-Universal Coverage Scheme (UCS) insurance, presence of liver disease, and opioid use, while statin use was negatively associated. Phenytoin and levetiracetam were the most commonly prescribed old- and new-generation AEDs, respectively. The study highlights evolving clinical practices in Thailand amid guideline updates and access limitations, emphasizing individualized treatment decisions for older epileptic patients.