Some Seizure Medicines May Be Safer In Dementia

What was studied

Researchers used Swedish national health registers to study people who had both dementia and epilepsy and then started an antiseizure medicine between 2006 and 2023. The study included 5,764 people in Sweden, about half men and half women.

They compared survival after starting the first antiseizure medicine. The main medicines studied were carbamazepine, levetiracetam, lamotrigine, and valproate. They also looked at causes of death, including cardiovascular death.

What they found

In this study, people who started valproate had the highest risk of death overall. Lamotrigine was associated with better survival, and levetiracetam was associated with better survival in some analyses. Carbamazepine was between these groups, and cardiovascular causes of death were more common among users of carbamazepine or valproate than among users of lamotrigine and levetiracetam. These patterns were similar across several different statistical analyses.

Limits of the evidence

This was an observational cohort study, not a randomized trial, so it cannot show that one medicine directly caused better or worse survival. People may have been given different medicines for reasons that also affect survival, even though the researchers adjusted for age, sex, year of treatment start, and comorbidities. The study used prescription and registry data from Sweden, so results may not fully apply to other countries or to people whose treatment details, seizure severity, dementia severity, dose, side effects, or reasons for choosing a drug were different. The abstract does not give details on all possible confounding factors.

For families and caregivers

For families, this study suggests that the choice of first antiseizure medicine may be linked with survival in older adults with both dementia and epilepsy. It provides real-world support for current expert guidance that often favors newer medicines such as lamotrigine or levetiracetam over valproate in this group. Treatment decisions still depend on the person’s overall health and other clinical factors.

What to watch next

Future studies could better measure dementia severity, seizure severity, drug dose, and reasons for prescribing, or use randomized trials if feasible.

Terms in this summary

antiseizure medicine

A medicine used to prevent or reduce seizures.

dementia

A group of conditions that cause problems with memory, thinking, and daily function.

cohort study

A study that follows a group of people over time to see what happens.

all-cause death

Death from any reason, not just one specific disease.

cardiovascular death

Death related to heart or blood vessel disease.

hazard ratio

A measure researchers use to compare the rate of an outcome between groups over time.

propensity score matching

A statistical method used to make comparison groups more similar in observational studies.