A robust multi-criteria decision-making approach for selecting optimal drugs in epilepsy treatment using the analytic hierarchy process

• AHP applied to optimize antiseizure medication selection in epilepsy treatment. • Seizure control, safety, and pharmacokinetics ranked top among selection criteria. • Patient age, cost, and compliance also influenced drug prioritization. • AHP provides transparent, rational, and patient-centered treatment decisions. • Study confirms AHP as a reliable tool for individualized epilepsy management. Epilepsy, a neurological disorder characterized by recurrent seizures, poses significant challenges in selecting the most appropriate antiseizure medication (ASM) due to the complex interplay of clinical, pharmacological, and patient-specific factors. This study applies the Analytic Hierarchy Process (AHP), a structured multi-criteria decision-making (MCDM) method, to systematically evaluate and prioritize key criteria in ASM selection. The criteria analyzed include seizure control efficacy, safety and tolerability, pharmacokinetics, age and comorbidities, drug interactions, cost, patient compliance, risk of dependency, and impact on quality of life. Based on a comprehensive literature review and the judgments of a multidisciplinary panel of thirty experts, including neurologists, pharmacologists, biostatisticians, health economists, epilepsy nurses, and academic researchers, a pairwise comparison matrix was developed to determine the relative importance of each factor. The analysis identified seizure control as the most critical criterion (weight = 0.143), followed by safety (0.129), pharmacokinetics (0.123), and patient age (0.111). Factors such as cost, compliance, and drug dependency also played notable but comparatively secondary roles. The integration of AHP into the decision-making process provides clinicians with a transparent and rational framework that accommodates multiple, often competing, variables to inform a personalized treatment strategy. This approach enhances the precision of clinical choices, particularly in complex cases, by aligning medication selection with both evidence-based findings and collective expert insight. Overall, the findings support the adoption of AHP as a valuable tool in epilepsy management, promoting more effective and individualized treatment decisions through the quantitative assessment of critical therapeutic factors.