To investigate the trends in antiseizure medications (ASM) use following ischaemic stroke and to examine factors associated with use of newer- and older-generation ASMs.
A retrospective cohort study was conducted using state-wide linked health datasets. Patients who were hospitalised with a first-ever ischaemic stroke between 2013-2017 and were dispensed ASM within 12 months from discharge were included. Logistic regression was used to examine the predictors of receiving newer-generation ASMs. Generalised linear modelling was used to identify factors associated with ASM use after ischaemic stroke.
Of 19,601 people hospitalized with a first-ever ischaemic stroke, 989 were dispensed an ASM within 12 months from discharge. The most prevalent first ASMs were levetiracetam (38.0%), valproate (25.8%) and carbamazepine (10.3%). Most people were dispensed ASM monotherapy (86.9%). There was a shift towards the use of newer-generation ASMs between 2013-2017 (Odds Ratio [OR] 2.82, 95% confidence interval [CI] 1.92-4.16). Metropolitan residents were more likely to be dispensed newer-generation ASMs as a first-line treatment (OR 1.79, 95% CI 1.31-2.45). People over 85 years (OR 0.38, 95% CI 0.23-0.64), with dementia (OR 0.35, 95% CI 0.19-0.63) and psychotic comorbidities (OR 0.29, 95% CI 0.09-0.96) were less likely to be dispensed newer-generation ASMs. Older age (coefficient [β] 0.23, p=0.030), history of beta blocker use (β 0.17, p=0.029), multiple ASMs (β 0.78, p<0.001) and newer-generation ASM (β 0.23, p=0.001) were associated with higher defined daily dose (DDD) of ASM whereas female sex and being married were associated with lower DDD.
There has been a shift toward newer-generation ASMs for post-stroke seizures and epilepsy. Concerningly, vulnerable patient groups were more likely to be dispensed older-generation ASMs. This may lead to unnecessary exposure to adverse events and drug-drug interactions. Further research is needed to evaluate comparative effectiveness and safety of newer- and older-generation ASMs in post-stroke populations.

© 2023 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.