Among patients with epilepsy in Singapore, those who use multiple antiseizure medications (ASMs) face a substantial burden of hospitalization, according to a study.
In a small cohort of patients followed up at an outpatient neuroscience specialist clinic for a median of 3.5 years, ASM polytherapy was associated with significantly higher incidence rates of all-cause hospitalization (incidence rate ratio [IRR], 3.45, 95 percent confidence interval [CI], 1.24–9.90; p=0.021) and epilepsy-related hospitalization (IRR, 7.59, 95 percent CI, 1.76–32.7; p=0.007). [Epilepsy Res 2026;doi:10.1016/j.eplepsyres.2026.107736]
“Most of the epilepsy-related hospitalizations in our cohort were due to seizure recurrence, and none were attributable to medication adverse effects. This suggests that … polytherapy was not the direct cause of epilepsy-related hospitalizations but was simply a marker of poor seizure control leading to a greater risk of epilepsy-related hospitalizations,” the investigators noted.
Furthermore, “the comorbidities associated with severe epilepsy requiring polytherapy also contribute significantly to [all-cause] hospitalization risk,” they added.
The analysis included 54 patients with epilepsy (median age 50.5 years, 48.1 percent female, 64.8 percent Chinese), most of whom had focal epilepsy (58.2 percent). The maximum number of ASMs taken concurrently during the study period was one for 37 percent of patients, two in 27.8 percent, three in 11.1 percent, four in 3.7 percent, and five in 1.9 percent.
Half of the patients had no hospital admissions during the entire study period. Among those who had been hospitalized, the median number of admissions per year was 0.61, and the median number of hospitalization days was 3.35. Overall, the incidence rate of all-cause hospitalizations was 0.679 per person-year.
The median number of epilepsy-related hospitalizations per year was 0.529, with the most common reasons being seizures (83.8 percent), functional seizures (8.1 percent), elective admission to the epilepsy monitoring unit (5.4 percent), and elective admission for epilepsy surgery (2.7 percent).
For hospitalization admissions due to non-epilepsy-related conditions, the most common reasons included elective admissions (27.1 percent), acute infections (12.5 percent), trauma or falls (11.5 percent), renal disease (9.4 percent), cancer (7.3 percent), psychiatric disease (4.2 percent), and cardiovascular disease (4.2 percent).
“Our observations are therefore consistent with other studies showing that poor seizure control often drives polytherapy, greater risk of status epilepticus, seizure-related injuries, and hospitalization burden,” the investigators said. [Front Neurol 2021;12:674483; Epilepsy Behav 2014:37:59-70]
“However, given our small sample size, our data does not indicate that hospital admissions for medication adverse effects never occur at all; it only indicates that admissions for medication adverse effects are less common than hospital admissions for seizures,” they added.
To reduce hospitalization and its associated socioeconomic impact among patients with epilepsy locally, the investigators recommended optimization of medication routine, adherence promotion, early referral for therapies, and proactive management of comorbidities. This is important, they said, given the expected increase in the prevalence of epilepsy.
“In Singapore, 20.7 percent of the population is at least 65 years old, and this figure is projected to rise to 23.9 percent by 2030. Epilepsy prevalence is expected to rise alongside this ageing population and increasing multimorbidity, with 20-year data showing a 14.7-percent increase in epilepsy prevalence,” the investigators said.