Real-world practices for the care of women with epilepsy during pregnancy: A Canadian perspective.

OBJECTIVE: Approximately 150,000 Canadian women live with epilepsy, a population that presents with unique challenges. Our objective was to capture demographic and real-world practice characteristics of Canadian healthcare professionals providing care for women with epilepsy (WWE) with specific focus on reproductive considerations to identify potential gaps in knowledge and care. METHODS: A questionnaire developed by the Canadian League Against Epilepsy WWE workgroup was distributed to Canadian healthcare professionals from February 2021 to October 2022 to capture participant demographic characteristics and practice patterns in key areas of the reproductive cycle in WWE. RESULTS: A total of 156 participants completed the questionnaire, most being physicians (81.4%), epilepsy specialists (69.0%), and those who cared for adult patients (86.5%), with a significant proportion based at an academic center (65.4%). The majority of participants counselled on folic acid supplementation (89.7%). Participants selected lamotrigine and levetiracetam most frequently for either focal or generalized epilepsies during pregnancy. Additionally, 85.9% performed therapeutic drug monitoring during pregnancy. Almost all practitioners always or often counseled WWE on valproic acid on the benefits of switching to a less teratogenic medication (96.2%). Some geographic variability in practice patterns was noted with valproic acid being one of the top three medications selected for patients with generalized epilepsies in Western regions, although participants in Eastern regions had brivaracetam more commonly included as one of their top three agents for this population. SIGNIFICANCE: This is the first report of real-world Canadian practices in epilepsy care for women in pregnancy. Overall, our study reports that Canadian practice patterns conform well to current evidence and best-practice guidelines. Important variations in antiseizure medication selection across different regions were identified.

The importance of mental health in improving quality of life in transition-aged patients with epilepsy.

OBJECTIVE: Adolescents with epilepsy are known to have a lower quality of life (QoL) than the typically developing adolescent population. In order to address this, treating physicians have primarily focused on obtaining seizure control. However, growing evidence suggests a strong relation between QoL and mental health in adults with epilepsy and other chronic conditions. Given the high rate of mental health issues in transition-aged adolescents with epilepsy, this study aimed to examine the relation between QoL and mental health. METHODS: Baseline data from 107 transition-aged adolescents (M = 16.08 years; 52 males, 55 females) enrolled in an epilepsy transition clinic were analyzed for this study. RESULTS: Analysis found that over 56% of participants showed some signs of mental illness, and that these participants had significantly lower QoL scores than those without mental health issues. Furthermore, regression analysis found that both depression and anxiety remained significant, independent predictors of QoL, even when significant epilepsy and demographic variables were accounted for (t(99) = -1.28, p < .001 and t(99) = -1.10, p = .002, respectively). SIGNIFICANCE: Results suggest that in order to ensure best outcomes for these adolescents, it may be important for clinicians to take a holistic approach to treatment, managing and treating both seizures and mental health concerns.

Effect of stimulus type and temperature on EEG reactivity in cardiac arrest.

OBJECTIVE: Electroencephalogram (EEG) background reactivity is a reliable outcome predictor in cardiac arrest patients post therapeutic hypothermia. However, there is no consensus on modality testing and prior studies reveal only fair to moderate agreement rates. The aim of this study was to explore different stimulus modalities and report interrater agreements. METHODS: We studied a multicenter, prospectively collected cohort of cardiac arrest patients who underwent therapeutic hypothermia between September 2014 and December 2015. We identified patients with reactivity data and evaluated interrater agreements of different stimulus modalities tested in hypothermia and normothermia. RESULTS: Of the 60 patients studied, agreement rates were moderate to substantial during hypothermia and fair to moderate during normothermia. Bilateral nipple pressure is more sensitive (80%) when compared to other modalities in eliciting a reactive background in hypothermia. Auditory, nasal tickle, nailbed pressure and nipple pressure reactivity were associated with good outcomes in both hypothermia and normothermia. CONCLUSIONS: EEG reactivity varies depending on the stimulus testing modality as well as the temperature during which stimulation is performed, with nipple pressure emerging as the most sensitive during hypothermia for reactivity and outcome determination. SIGNIFICANCE: This highlights the importance of multiple stimulus testing modalities in EEG reactivity determination to reduce false negatives and optimize prognostication.