Trends in Antiepileptic Drug Use in Children and Adolescents With Epilepsy

Pediatr Neurol. 2017 Sep:74:32-40. doi: 10.1016/j.pediatrneurol.2017.05.016. Epub 2017 May 29.


Objective: We describe the trends in antiepileptic drug (AED) use in children and adolescents with epilepsy in the United States.

Methods: We undertook a cross-sectional study based on Medicaid Analytic eXtract data set from 26 US states. Children and adolescents aged three to 18 years with at least one year continuous Medicaid fee-for-service coverage after the second outpatient or the first inpatient diagnosis of epilepsy in each calendar year during 1999 to 2009 were included in the study; therefore, 11 cohorts were established. A patient was defined as being exposed to a specific AED if he or she had at least one-day supply of the AED during the 1-year follow-up period. The annual prevalence of AEDs was reported, stratified by gender and age. The trends in AED use were evaluated through linear regression.

Results: The sample sizes of the 11 cohorts ranged between 17,304 and 22,672. The annual prevalence of valproic acid use declined from 42.4% in 1999 to 26.5% in 2009, and the prevalence of carbamazepine use declined from 37.1% to 10.2%. Meanwhile, the prevalence of levetiracetam use increased from 5.1% to about 32.0% in 2009, and the prevalence of oxcarbazepine use increased from 1.3% to 19.1%. Since 2008, levetiracetam (29.6%) has replaced valproic acid (27.8%) as the most commonly used AED in children and adolescents with epilepsy. The prevalence of diazepam use increased from 11.6% to 28.1%.

Significance: Compared with first- and second-generation antiepileptic drugs, third-generation AEDs have fewer adverse side effects, resulting in increased patient treatment adherence. Equally important is the economic impact of these newer AEDs. This first-of-its-kind study underscores the need for large database studies that objectively assess the cost-effectiveness of third-generation AEDs versus first- and second-generation AEDs in the treatment of childhood epilepsy.

Keywords: adolescents; antiepileptic drugs; children; epilepsy; medicaid.

MeSH terms

  • Adolescent
  • Anticonvulsants / economics
  • Anticonvulsants / therapeutic use*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cost-Benefit Analysis
  • Epilepsy / drug therapy*
  • Epilepsy / epidemiology*
  • Female
  • Humans
  • Male
  • Medicaid / statistics & numerical data
  • Medicaid / trends*
  • Statistics as Topic
  • Time Factors
  • United States / epidemiology


  • Anticonvulsants