Table 2_Efficacy, treatment retention, and tolerability of newer- versus older-generation antiseizure medications in older adults with epilepsy: a systematic review and meta-analysis.xlsx

Overall seizure freedom did not differ significantly between the two medication categories (RR = 1.18, 95% CI 0.80–1.76; I² = 93%), and the restricted sensitivity analysis remained non-significant (RR = 1.11, 95% CI 0.94–1.30). No significant difference was observed in seizure-free retention. Newer-generation ASMs were associated with higher treatment retention (RR = 1.34, 95% CI 1.22–1.47), with the inverse outcome of withdrawal for any reason correspondingly lower (RR = 0.71, 95% CI 0.64–0.80); adverse-event-related discontinuation was also lower (RR = 0.54, 95% CI 0.45–0.64).

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 = 1.30, 95% CI 0.81–2.08; I² = 77%).</p>Conclusion<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.</p>