Abstract Details

Title Antiepileptic Drug (AED) Treatment in Juvenile Myoclonic Epilepsy (JME): a Population-based Study

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P14 - Poster Session 14 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-003

Objective To examine the prevalence of intractable Juvenile Myoclonic Epilepsy (JME) and to investigate differences in antiepileptic drugs (AEDs) treatment between persons with and without intractability.

Background Most JME are considered to be responsive to appropriate AEDs. However, little is reported about AED treatment patterns, such as treatment regimen and doses.

Design/Methods We performed a population-based study using a U.S. nationwide claims database from the Optum^Ò ClinformaticsÔ Data Mart (10/2015-12/2017). JME cases were identified by ICD-10-CM diagnosis codes. We analyzed 22 AEDs. Outcomes were the frequency of intractable JME and differences in treatment regimen (i.e., monotherapy, polytherapy, and switched regimen) and doses (i.e., lower and higher than defined daily doses measured by prescribed daily dose (PDD)/defined daily dose (DDD) ratio) between persons with and without intractability, controlling for demographic characteristics, socioeconomic status, and psychiatric comorbidity.

Results Among 1530 persons with JME (median [IQR] age=26 [9-37] years; female=915 [59.8%]), 313 (20.5%) had intractability. AEDs were prescribed in 1406 (91.9%). Monotherapy was prevalent in non-intractable JME relative to intractable JME (63.0% vs. 37.8%, p=0.000). Polytherapy and switched regimen were frequently prescribed in both non-intractable (19.2% and 17.8%) and intractable JME (27.1% and 35.1%). After controlling for age, sex, race, education level, household incomes, and psychiatric comorbidity, persons with intractable JME were more likely to undergo polytherapy (OR=2.4, 95% CI=1.2-4.7, p=0.013) and switched regimen (OR=2.5, 95% CI=1.3-4.9, p=0.009). High-dose ratio (PDD/DDD>1) was prevalent in most commonly prescribed 5 AEDs for both non-intractable and intractable JME: levetiracetam (40.6% vs. 58.6%, p=0.000), lamotrigine (51.7% vs. 63.3%, p=0.033), valproic acid (13.6% vs. 20.8%, p=0.153), zonisamide (66.9% vs. 76.6%, p=0.234), and topiramate (16.0% vs.36.2%, p=0.010).

Conclusions Polytherapy, switched regimen, as well as high-dose AEDs were frequently applied for JME treatment regardless of intractability. This finding suggests that JME is less likely to have a benign course.

Authors/Disclosures
Ahyuda Oh, PhD (StanfordUniversity School of Medicine) PRESENTER	Dr. Oh has nothing to disclose.
Hyunmi Kim, MD (Stanford University)	Dr. Kim has nothing to disclose.

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Abstract Details