Student University of California Davis, VA Greater Los Angeles Healthcare System Woodland Hills, California
This abstract has been invited to present during the Better Patient Outcomes through Diversity Platform poster session
Rationale: Use of antiseizure medications (ASMs) is associated with an increased risk of psychiatric adverse drug reactions (ADRs), the most common being depression, anxiety, and aggression. In practice, when patients develop psychiatric ADRs to an ASM they are transitioned off the offending ASM despite it being efficacious. However, there is a paucity of evidence of this phenomenon in the veteran population. Veterans have higher prevalence of traumatic brain injury (TBI) and psychiatric disorders. We evaluated the role of ASM-related psychiatric ADRs in medically refractory focal-onset epilepsy patients with and without established psychiatric comorbidities. Methods: We conducted a retrospective chart review of all veterans seen in Seizure Clinic at the Veterans Affairs West Los Angeles Healthcare Center from July 1, 2008 to June 30, 2017. Patients with medically refractory epilepsy (MRE) and known ADRs were included in the analysis. MRE status was determined based on ILAE criteria. ADRs were recorded for each ASM. Responses to each of the ASMs were recorded using ILAE drug response criteria. Additional data points collected included baseline characteristics, duration of epilepsy, history of TBI, comorbid disease states, current and past ASMs, reason discontinuation of ASMs, and adherence of ASMs. Results: Of 483 veterans seen in clinic, 249 reported having an ADR to at least one of their past ASMs. Of these 249 veterans, 91% were male and the mean age was 58 years. Nearly half the population (49.4%) had a comorbid psychiatric condition. About 25% reported having a psychiatric ADR to their past ASMs. Of those veterans with a co-morbid psychiatric condition, 30% discontinued an ASM due to a reported psychiatric ADR. In comparison, 21% of veterans without a psychiatric condition reported having a psychiatric ADR to their past ASMs. While a Chi-square test indicated that the difference in psychiatric ADRs between the two groups was not significant (p-value = 0.087), veterans with psychiatric comorbidities had higher rates of tried and discontinued ASMs (64% vs. 36%). Conclusions: The results of our study suggest that having a comorbid psychiatric condition may not increase a veteran’s likelihood to report a psychiatric ADR for their ASM. However, while our dataset had nearly equal representations of veterans with and without psychiatric comorbidities, veterans with a psychiatric comorbidity appeared to have higher number of discontinued ASMs even when controlling for duration of epilepsy. Funding: Please list any funding that was received in support of this abstract.: No funding.