Seizure Medicine Use Shifted While Costs Fell In Germany

What was studied

This study looked at national prescription data in Germany from 2000 to 2024 to examine how often anti-seizure medicines were prescribed and how their prices changed over time. The researchers used yearly records from a national prescription report and measured cost per defined daily dose, which is a standard way to compare medicine costs.

They excluded gabapentin and pregabalin because those drugs are often used for conditions other than epilepsy, which could have distorted the results. The study focused on broad national trends rather than on individual patients, so it does not describe how well specific medicines worked for particular people.

What they found

Over 25 years, prescribing patterns changed substantially. Levetiracetam went from almost no use to about 35% of prescriptions, making it the most commonly prescribed anti-seizure medicine in Germany. Lamotrigine was next at about 20%, followed by valproate at about 16%. Carbamazepine dropped from more than 45% to under 10%. Other newer medicines, including lacosamide, eslicarbazepine, perampanel, brivaracetam, and cenobamate, also gained use after they entered the market.

Newer medicines entered the market at a high cost per defined daily dose, and these costs decreased substantially following statutory healthcare reforms, reimbursement negotiations, or generic availability, which the interrupted time-series analysis supported. Even though newer drugs kept being introduced, the median cost per defined daily dose decreased over time. By 2024, total anti-seizure medicine spending had fallen to about 300 million euros, which was more than 100 million euros lower than in 2021.

The authors state that these prescription shifts align with German treatment guidelines, which recommend lamotrigine, levetiracetam, and lacosamide as first-line options for focal epilepsies and discourage older enzyme-inducing drugs because of interaction and long-term tolerability concerns.

Limits of the evidence

This was a study of prescription and cost data, not a clinical trial. It cannot prove that the changes in prescribing were caused by guidelines or policy changes, even though the timing was examined and the trends were consistent with these factors. It also cannot show which medicines worked best, caused fewer side effects, or were best for quality of life.

Because the data were national and grouped together, the study does not show results by age, seizure type, severity, or other patient factors. It also reflects Germany's health system, pricing rules, and prescribing habits, so the findings may not apply the same way in other countries. The abstract does not give detailed information about individual patient outcomes.

For families and caregivers

For families, this study suggests that medicine choices for epilepsy in Germany have shifted toward newer drugs that guidelines often prefer, while overall national spending remained contained and even declined in recent years. This may be reassuring in suggesting that access to newer treatments can increase without a parallel rise in total national spending.

Still, this study does not tell which medicine is best for any one child or adult. Treatment decisions depend on the type of epilepsy, age, side effects, other medicines, pregnancy concerns, and many other factors.

What to watch next

Useful next steps would include patient-level studies showing whether these prescribing changes were associated with differences in seizure control, side effects, and quality of life.

Terms in this summary

defined daily dose

A standard unit used to compare medicine use and cost across drugs, based on a typical daily amount.

generic availability

When lower-cost versions of a brand-name medicine become available after patent protections end.

reimbursement negotiations

Talks that help decide how much the health system will pay for a medicine.

enzyme-inducing ASMs

Older anti-seizure medicines that can change how the body processes other drugs, leading to more drug interactions.

focal epilepsy

Epilepsy in which seizures start in one area of the brain.