{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T07:00:13Z","timestamp":1789974013613,"version":"4.0.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Older adults with epilepsy frequently have multiple comorbidities, polypharmacy, and reduced medication tolerance; therefore, ASM selection must consider seizure control, treatment persistence, and tolerability. This study compared the efficacy and safety outcomes of newer-generation and older-generation ASMs in older adults with epilepsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, Web of Science Core Collection, and the Cochrane Library were searched from inception to April 30, 2026. Comparative clinical studies evaluating newer-generation versus older-generation ASMs in populations defined as older adults by the original studies were eligible. The primary outcome was seizure freedom; secondary outcomes included seizure-free retention, treatment retention, withdrawal for any reason, discontinuation due to adverse events, and adverse reactions. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using fixed- or random-effects models according to statistical and clinical heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine studies involving 2,507 participants were included, comprising randomized, open-label,\n                      <jats:italic>post-hoc<\/jats:italic>\n                      subgroup, and retrospective evidence. Overall seizure freedom did not differ significantly between the two medication categories (RR\u202f=\u202f1.18, 95% CI 0.80\u20131.76;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f93%), and the restricted sensitivity analysis remained non-significant (RR\u202f=\u202f1.11, 95% CI 0.94\u20131.30). No significant difference was observed in seizure-free retention. Newer-generation ASMs were associated with higher treatment retention (RR\u202f=\u202f1.34, 95% CI 1.22\u20131.47), with the inverse outcome of withdrawal for any reason correspondingly lower (RR\u202f=\u202f0.71, 95% CI 0.64\u20130.80); adverse-event-related discontinuation was also lower (RR\u202f=\u202f0.54, 95% CI 0.45\u20130.64). In the exploratory post-stroke analysis based on two randomized studies, the random-effects estimate did not show a significant difference in seizure freedom (RR\u202f=\u202f1.30, 95% CI 0.81\u20132.08;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f77%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Across a small and clinically heterogeneous evidence base, seizure freedom did not clearly differ between newer- and older-generation ASMs, whereas treatment retention and adverse-event-related discontinuation favored newer-generation agents; however, the certainty of evidence was low or very low. These class-level findings should be interpreted cautiously because the medication categories were pharmacologically heterogeneous and the evidence included mixed study designs, variable age definitions, and inconsistent outcome windows.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1902489","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:05:17Z","timestamp":1789970717000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy, treatment retention, and tolerability of newer- versus older-generation antiseizure medications in older adults with epilepsy: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Changyan","family":"Fan","sequence":"first","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Jiangnan University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaosheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Jiangnan University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyan","family":"Sui","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Jiangnan University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Likun","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Jiangnan University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Jiangnan University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Hospital of Jiangnan University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"106724","DOI":"10.1016\/j.yebeh.2019.106724","article-title":"Epilepsy in the elderly: unique challenges in an increasingly prevalent population","volume":"102","author":"Lezaic","year":"2020","journal-title":"Epilepsy Behav"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1212\/wnl.0000000000003509","article-title":"Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international 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