Demographics and care of epilepsy in older adults in Germany

PURPOSE: Epilepsy is one of the most frequent chronic neurological disorders worldwide and is increasingly significant in individuals aged over 65 years due to rising life expectancy and comorbidities. This study aims to improve epilepsy care by examining demographic changes and treatment parameters in patients aged 65 and older in Germany. METHODS: Data from the IQVIA™ LRx and Disease Analyzer (DA) databases (2018-2022) were analyzed for epilepsy patients 65+. The LRx database provided prescription data, while DA offered diagnostic and demographic information. Multivariable logistic regression analysis was conducted to evaluate the association between age, sex, region, physician specialty and pre-defined outcomes, i.e., therapy delay and adherence. RESULTS: In 2022, the DA database estimated epilepsy prevalence at 0.64 % (65-74: 0.91 %; 75+: 1.32 %), and LRx at 0.67 % (65-74: 0.97 %; 75+: 1.75 %). Regional differences in prevalence, incidence, and treatment were observed, with geographic gradients visualized. Most patients (63 %) received anti-seizure medication (ASM) on diagnosis day, but neurologists prescribed ASMs later than GPs, especially in those over 75. Age 75+ was associated with significantly lower odds of therapy delay (adjusted odds ratio; AOR = 0.79, p 0.004), and male gender with a slightly reduced risk of delay (AOR = 0.91, p 0.003). Treatment by neurologists was associated with a higher adherence (AOR = 1.85, p < 0.001) but greater therapy delays (AOR = 1.19, p < 0.001) compared with GPs. Third-line therapies improved adherence across all ages (AOR = 2.09, p < 0.001). CONCLUSION: The study highlights a higher prevalence of epilepsy in older adults than previously estimated and significant differences in treatment timing and adherence between GPs and neurologists. Further research is needed to explore regional treatment disparities and improve care for elderly epilepsy patients.