Trends in Antiepileptic Drug Use in Pharmacoresistant Epilepsy

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.