Modern Approaches to Antiseizure Medication Therapy in Patients with Epilepsy

Abstract

Objective. The present study aimed to comparatively evaluate the dynamics of changes in antiseizure medication (ASM) treatment strategies among patients with epilepsy registered in Ganja during the periods 2005–2009 and 2019–2023, and to analyze the relationship between serum drug concentrations and seizure frequency using statistical modeling. The study was designed to identify temporal transformations in therapeutic approaches and to determine the impact of therapeutic drug monitoring on clinical outcomes. Material and Methods.
A retrospective comparative design was employed. Clinical data of patients with epilepsy registered in Ganja during 2005–2009 and 2019–2023 were analyzed. Treatment strategies (monotherapy, polytherapy, and untreated cases), the main ASMs used (Depakine, carbamazepine, lamotrigine, levetiracetam), and their serum concentrations were evaluated. The association between drug levels and seizure frequency was assessed using correlation analysis, graphical visualization, and regression modeling. Both linear and nonlinear (polynomial) regression models were constructed, and their explanatory power was evaluated using the coefficient of determination (R²). Results. Comparative analysis demonstrated that over the past decade, epilepsy management has shifted toward more modern, standardized, and individualized treatment approaches. During 2019–2023, the number of untreated patients decreased, monotherapy became more prevalent, and newer-generation ASMs were more widely integrated into clinical practice. Analysis of the relationship between serum drug concentrations and seizure frequency revealed no clear linear correlation for classical agents (Depakine and carbamazepine). In contrast, for lamotrigine and levetiracetam, a statistically significant nonlinear relationship was identified, whereby decreased drug concentrations were associated with increased seizure frequency. Polynomial regression models yielded high R² values, indicating a stronger capacity to explain clinical variability compared to linear models. Conclusion. The findings suggest that effective epilepsy management extends beyond the selection of an antiseizure medication. Optimal clinical control requires the implementation of therapeutic drug monitoring, consideration of individual pharmacokinetic variability, and dynamic optimization of treatment strategies. This integrated approach may be regarded as a fundamental prerequisite for achieving long-term remission and sustained seizure control.