Kristal Xie,1,2 Caroline Ulep,1 Carson Konop,1 Kammiee-Marie Ardo,1 Janette Bow-Keola,2 Matthew Kao,2 Tyrone John P. Sumibcay,2 Haley Yamamoto,1,2 Darren Dugas,1 Enrique Carrazana,2 Kore Liow1,2
1 Comprehensive Epilepsy Center and Video-EEG Epilepsy Monitoring Unit & Epilepsy Research Unit, Hawaii Pacific Neuroscience, Honolulu, HI
2 John A. Burns School of Medicine, University of Hawaiʻi, Honolulu, HI
Background: Anti-seizure medications (ASMs) are the primary treatment for epilepsy, but many patients fail to achieve seizure control or require polypharmacy. Despite the importance of ASM adherence to prevent seizures, little is known about their use in diverse populations.
Methods: A retrospective cohort chart review of electronic health records was conducted. Eligible patients included adults (≥18 years) with epilepsy, an active ASM prescription, and ≥2 clinical encounters in 12 months. Data from 2019–2024 were analyzed, including demographics, clinical variables, ASM regimen, dose comparisons, and outcome metrics.
Results: In the cohort of 71 patients, 23% were Asian, 23% were Caucasian, 20% were Native Hawaiian, and 9% were Other Pacific Islander. Among 50 patients, levetiracetam was the most common monotherapy (61%), and levetiracetam, lamotrigine, and lacosamide were most frequently used in polypharmacy. Among seizure-free patients, 60% were below, 37% were within, and 3% were above the FDA label range. In patients with uncontrolled seizures, 85% were below, and 15% were within the FDA range.
Conclusion: The seizure-controlled patients were more likely to be dosed within the FDA-approved range; further research is needed to better understand real-world ASM dosing patterns.
