2026-10-11T12:58:45Z https://api.figshare.com/v2/oai

oai:figshare.com:article/33950437 2026-09-21T06:05:19Z category_363 portal_316 item_type_3 month_year_09_2026

Table 2_Efficacy, treatment retention, and tolerability of newer- versus older-generation antiseizure medications in older adults with epilepsy: a systematic review and meta-analysis.xlsx Changyan Fan (25080784) Chaosheng Li (3180048) Chenyan Sui (25080787) Likun Han (14000205) Xin Gu (244758) Yong Liu (6908) Neurology and Neuromuscular Diseases antiseizure medications epilepsy meta-analysis older adults seizure freedom treatment retention Objective<p>Older adults with epilepsy frequently have multiple comorbidities, polypharmacy, and reduced medication tolerance; therefore, ASM selection must consider seizure control, treatment persistence, and tolerability. This study compared the efficacy and safety outcomes of newer-generation and older-generation ASMs in older adults with epilepsy.</p>Methods<p>PubMed, Embase, Web of Science Core Collection, and the Cochrane Library were searched from inception to April 30, 2026. Comparative clinical studies evaluating newer-generation versus older-generation ASMs in populations defined as older adults by the original studies were eligible. The primary outcome was seizure freedom; secondary outcomes included seizure-free retention, treatment retention, withdrawal for any reason, discontinuation due to adverse events, and adverse reactions. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using fixed- or random-effects models according to statistical and clinical heterogeneity.</p>Results<p>Nine studies involving 2,507 participants were included, comprising randomized, open-label, post-hoc subgroup, and retrospective evidence. Overall seizure freedom did not differ significantly between the two medication categories (RR = 1.18, 95% CI 0.80–1.76; I² = 93%), and the restricted sensitivity analysis remained non-significant (RR = 1.11, 95% CI 0.94–1.30). No significant difference was observed in seizure-free retention. Newer-generation ASMs were associated with higher treatment retention (RR = 1.34, 95% CI 1.22–1.47), with the inverse outcome of withdrawal for any reason correspondingly lower (RR = 0.71, 95% CI 0.64–0.80); adverse-event-related discontinuation was also lower (RR = 0.54, 95% CI 0.45–0.64). In the exploratory post-stroke analysis based on two randomized studies, the random-effects estimate did not show a significant difference in seizure freedom (RR = 1.30, 95% CI 0.81–2.08; I² = 77%).</p>Conclusion<p>Across a small and clinically heterogeneous evidence base, seizure freedom did not clearly differ between newer- and older-generation ASMs, whereas treatment retention and adverse-event-related discontinuation favored newer-generation agents; however, the certainty of evidence was low or very low. These class-level findings should be interpreted cautiously because the medication categories were pharmacologically heterogeneous and the evidence included mixed study designs, variable age definitions, and inconsistent outcome windows.</p> 2026-09-21T06:05:19Z Dataset Dataset 10.3389/fneur.2026.1902489.s002 https://figshare.com/articles/dataset/Table_2_Efficacy_treatment_retention_and_tolerability_of_newer-_versus_older-generation_antiseizure_medications_in_older_adults_with_epilepsy_a_systematic_review_and_meta-analysis_xlsx/33950437 CC BY 4.0