NEW USE OF ANTICONVULSANT MEDICATIONS AMONG CHILDREN ENROLLED IN THE TENNESSEE MEDICAID PROGRAM

Objective: To describe the new use of anticonvulsant medications among children enrolled in the Tennessee Medicaid program. Design: A retros pective cohort study. Patients: New users of anticonvulsant medication s in 1992 were identified from the 206098 children (aged 0-18 years) e nrolled continuously for 12 months in the Aid to Families With Depende nt Children program or foster care program of Tennessee Medicaid. Main Outcome Measures: New users were categorized according to the diagnos is codes of health care encounters occurring 90 days before to 90 days after the first anticonvulsant prescription was filled as having diag noses consistent with (1) epilepsy or convulsions, (2) neonatal seizur es, (3) central nervous system disease, (4) no epilepsy diagnoses but diagnoses for which anticonvulsants might appropriately be used (jaund ice, headaches, or psychiatric disorders), or (5) no diagnoses for whi ch an anticonvulsant might appropriately be used. The children in each group were described according to sociodemographic variables, with lo gistic regression used to analyze variations in the subsequent filling of anticonvulsant prescriptions. Results: Of 647 children continuousl y enrolled in the Tennessee Medicaid program who were new anticonvulsa nt users in 1992, 58% had at least 1 health care encounter coded as ep ilepsy or convulsions, 2% had a diagnosis of neonatal seizures, 8% had central nervous system diagnoses, 16% had specific nonepilepsy diagno ses (jaundice,headache,or psychiatric diagnosis), and 16% had no diagn oses for which anticonvulsants might appropriately be prescribed. For children with epilepsy diagnoses, white race (P=.002) and undergoing t ests (P<.001) were independent predictors of a child filling 6 or more prescriptions in the year following the first prescription. Conclusio ns: A large proportion of new users of anticonvulsants among children enrolled in the Tennessee Medicaid program received these medications for indications other than epilepsy. For children with epilepsy diagno ses, there was considerable variation in the subsequent filling of pre scriptions. Further analysis of these variations in practice will allo w for the development of policies that will maximize benefit for child ren who need anticonvulsant therapy, while diminishing unnecessary exp osure to potentially toxic drugs for children who do not.