Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study

Area of Science:

• Pharmacology
• Neurology
• Public Health

Background:

• Polypharmacy, the use of multiple medications, is a growing concern in patient care.
• Patients with epilepsy often manage complex conditions requiring various medications, increasing the risk of polypharmacy.

Purpose of the Study:

• To determine the prevalence of polypharmacy and central nervous system (CNS)-acting medications in US adults with epilepsy.
• To identify specific types of CNS-acting medications and drugs that lower the seizure threshold used by this population.

Main Methods:

• A retrospective, cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) from 2013-2016.
• Analysis included patients reporting at least one antiseizure medication (ASM), assessing medication counts, types, and predictors of polypharmacy using negative binomial regression.

Main Results:

• The study identified 2,399,520 US citizens with epilepsy using ASMs.
• Nearly half (47%) of patients experienced polypharmacy (≥5 medications), and 34% had CNS polypharmacy (≥3 CNS-acting medications).
• Commonly used CNS medications included benzodiazepines (21%) and opioids (16%), with 6% using both. Additionally, 6% used seizure threshold-lowering drugs.

Conclusions:

• Polypharmacy is highly prevalent among patients with epilepsy, frequently involving CNS-acting medications and potentially risky combinations.
• The frequent use of medications with black box warnings highlights significant health risks associated with CNS polypharmacy.
• Further research is crucial to understand the drivers of polypharmacy and develop strategies to mitigate harmful medication use in this vulnerable patient group.