Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy ☆ Natalie N. Rohde a,b,1 , Christine B. Baca c,d,2 , Anne C. Van Cott e,f,3 , Karen L. Parko g,h,4 , Megan E. Amuan i,k,5 , Mary Jo Pugh a,b,j, ⁎ a VA Epilepsy Centers of Excellence, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA b Department of Epidemiology and Biostatistics, UTHSCSA, San Antonio, TX, USA c VA Epilepsy Center of Excellence, VAGLAHS, Los Angeles, CA, USA d Department of Neurology, UCLA, 710 Westwood Plaza, Los Angeles, CA 90095, USA e VA Pittsburgh Healthcare System, University of Pittsburgh, University Drive C, Pittsburgh, PA 15240, USA f Department of Neurology, University of Pittsburgh, PA, USA g VA Epilepsy Centers of Excellence, San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA h Department of Neurology, University of California, San Francisco, San Francisco, CA, USA i Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA j Texas A&M Health Science Center, Department of Medicine, Bryan, TX, USA k Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, 200 Springs Road (152), Bedford, MA 01730, USA abstract article info Article history: Received 15 December 2014 Revised 25 March 2015 Accepted 27 March 2015 Available online xxxx Keywords: Epilepsy/seizures Antiepileptic drugs Cohort studies Afghanistan war veterans Iraq war veterans Medical care Objective: We examined patterns of antiepileptic drug (AED) use in a cohort of Iraq/Afghanistan war veterans (IAVs) who were previously identified as having epilepsy. We hypothesized that clinicians would be more likely to prescribe newer AEDs and would select specific AEDs to treat seizures based on patient characteristics includ- ing gender and comorbidities. Methods: From the cohort of IAVs previously identified with epilepsy between fiscal years 2009 and 2010, we selected those who received AEDs from the Veterans Health Administration in FY2010. Regimens were classified as monotherapy or polytherapy, and specific AED use was examine overall and by gender. Multivariable logistic regression examined associations of age; gender; race/ethnicity; medical, psychiatric, and neurological comorbidities; and receipt of neurology specialty care associated with the six most commonly used AEDs. Results: Among 256,284 IAVs, 2123 met inclusion criteria (mean age: 33 years; 89% men). Seventy-two percent (n = 1526) received monotherapy, most commonly valproate (N = 425) and levetiracetam (n = 347). Sixty-one percent of those on monotherapy received a newer AED (levetiracetam, topiramate, lamotrigine, zonisamide, oxcarbazepine). Although fewer women than men received valproate, nearly 90% (N = 45) were of reproductive age (≤45 years). Antiepileptic drug prescribing patterns were associated with posttraumatic stress disorder, bipolar disorder, cerebrovascular disease, dementia/cognitive impairment, headache, and receipt of neurological specialty care (all p b 0.01). Epilepsy & Behavior xxx (2015) xxx–xxx Abbreviations: AAN, American Academy of Neurology; AED, antiepileptic drug; AES, American Epilepsy Society; CA, California; CBZ, carbamazepine; CVD, cerebrovascular disease; FDA, Federal Drug Administration (Food and Drug Administration in the Introduction); FY, fiscal year; HIPAA, Health Insurance Portability and Accountability Act; IAVs, Iraq/Afghanistan war vet- erans; ILAE, International League Against Epilepsy; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; LEV, levetiracetam; LTG, lamotrigine; MA, Master of Arts; MD, Doctor of Medicine; MPH, Master of Public Health; MS, Master of Science; MSHS, Master of Science in Health Sciences; NEAD, Neurodevelopmental Effects of Antiepileptic Drugs; OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; OXC, oxcarbazepine; PHE, phenobarbital; PhD, Doctor of Philosophy; PHT, phenytoin; PTSD, posttraumatic stress disorder; RN, Registered Nurse; SAS, Statistical Analysis System Software; SUD, substance use disorder; TBI, traumatic brain injury; TPM, topiramate; U.K., United Kingdom; U.S., United States; UCLA, University of California, Los Angeles; VA, Veteran Affairs; VAGLAHS, Veteran Affairs Greater Los Angeles Healthcare System; VAPHS, Veteran Affairs Pittsburgh Healthcare System; VHA, Veteran Health Administration; VPA, valproate; ZON, zonisamide. ☆ Data analysis was conducted by Ms. Amuan, Health Statistician at the Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA. ⁎ Corresponding author at: South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA. Tel.: +1 210 842 3807; fax: +1 210 567 4423. E-mail addresses: Natalie.Rohde@VA.gov (N.N. Rohde), CBower@mednet.ucla.edu (C.B. Baca), Anne.VanCott@va.gov (A.C. Van Cott), karen.parko@ucsf.edu (K.L. Parko), megan.amuan@va.gov (M.E. Amuan), MaryJo.Pugh2@VA.gov (M.J. Pugh). 1 Tel.: +1 210 617 5300x17292. 2 Tel.: +1 310 206 7671. 3 Tel.: +1 412 360 6185. 4 Tel.: +1 415 750 2011. 5 Tel.: +1 781 687 2879. YEBEH-04290; No of Pages 7 http://dx.doi.org/10.1016/j.yebeh.2015.03.027 1525-5050/© 2015 Published by Elsevier Inc. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh Please cite this article as: Rohde NN, et al, Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy, Epilepsy Behav (2015), http://dx.doi.org/10.1016/j.yebeh.2015.03.027