Network analysis of antiseizure medication use, efficacy, and safety in epilepsy: A retrospective cohort study in a tertiary care center

Antiseizure medications (ASMs) remain the cornerstone of epilepsy treatment, yet data on prescription patterns, effectiveness, and safety in low- and middle-income countries are limited. This retrospective cohort study analyzed changes in ASM use, efficacy, and adverse effects across 10 years in a tertiary care center in Mexico, comparing two phases: 2011–2013 (n = 100) and 2021–2023 (n = 128). Data on seizure freedom, adverse effects, and ASM patterns were analyzed using descriptive statistics and comparative tests. Network analysis and centrality measures were performed with MATLAB Version 9.12.0 to explore the relationships among prescribed ASMs and their influence on outcomes. A total of 228 patients were included. Seizure freedom rates increased from 9 % in the first phase to 25.8 % in the second (p = 0.001). Valproic acid remained the most frequently prescribed ASM, while levetiracetam use markedly increased (49 %). Adverse effects rose from 10 % to 17 % despite a modest reduction in polytherapy (93 % to 87.5 %). The network analysis revealed clusters of ASMs commonly prescribed together that were associated with seizure freedom (valproic acid, lamotrigine, topiramate), whereas combinations including phenobarbital and lamotrigine were linked to more adverse effects. Valproate continues to play a key role in seizure control due to its efficacy, accessibility, and broad-spectrum profile. Despite advances in newer ASM use and improved seizure outcomes, adverse effects remain a concern. Continued monitoring of ASM combinations is warranted to better understand evolving treatment patterns and guide epilepsy management in resource-limited settings.