Pub Date : 2024-10-10DOI: 10.1016/j.yebeh.2024.110080
Mary Lou Smith
This review addressed health-related quality of life (HRQOL) in children with medically refractory epilepsy and the impact of epilepsy surgery on HRQOL. Risk factors for poor HRQOL include the presence of cognitive, emotional or behavioural comorbidities, parental anxiety and depression, lower family socioeconomic status, stress and demands on the family, epilepsy-related variables and anti-seizure medications. Follow-up studies after epilepsy surgery have identified improvements in HRQOL, although findings are variable with respect to which aspects improved and which child, parent and family factors are associated with improvements. The key and consistent predictor is seizure freedom. Further research utilizing longitudinal designs and longer follow-up durations is needed to identify the timing and trajectories of improvements in HRQOL after surgery.
{"title":"It’s all about quality: Life after pediatric epilepsy surgery","authors":"Mary Lou Smith","doi":"10.1016/j.yebeh.2024.110080","DOIUrl":"10.1016/j.yebeh.2024.110080","url":null,"abstract":"<div><div>This review addressed health-related quality of life (HRQOL) in children with medically refractory epilepsy and the impact of epilepsy surgery on HRQOL. Risk factors for poor HRQOL include the presence of cognitive, emotional or behavioural comorbidities, parental anxiety and depression, lower family socioeconomic status, stress and demands on the family, epilepsy-related variables and anti-seizure medications. Follow-up studies after epilepsy surgery have identified improvements in HRQOL, although findings are variable with respect to which aspects improved and which child, parent and family factors are associated with improvements. The key and consistent predictor is seizure freedom. Further research utilizing longitudinal designs and longer follow-up durations is needed to identify the timing and trajectories of improvements in HRQOL after surgery.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.yebeh.2024.110070
Shengyi Liu, Zihua He, Wenyan Shi, Jinmei Li
Objective
Epilepsy is one of the most common neurological diseases. Current evidence suggests that the apolipoprotein E (APOE) gene may be related to epilepsy. The purpose was to explore whether the APOE gene is associated with the risk, characteristics, and prognosis of epilepsy.
Methods
The study was a systematic review and meta-analysis. We searched WANFANG, VIP, CNKI, Embase, CENTRAL, and Medline for relevant studies published in English and Chinese inception up to December 27, 2023. Studies containing both APOE genotypes or at least one type of APOE allele and epilepsy were included.
Results
A total of 46 studies were included. Fourteen studies reported APOE genotypes and epilepsy risk (2539 patients and 2847 controls). The meta-analyses showed that the APOE 4 was higher in epilepsy (OR [95 % CI] = 1.32 [1.07, 1.62], I2 = 30 %), the APOE 2 was lower in epilepsy (OR [95 % CI] = 0.73 [0.62, 0.87], I2 = 0 %), and the APOE 3 didn’t differ between epilepsy and controls (OR [95 % CI] = 1.01 [0.86, 1.19], I2 = 29 %). Our findings highlight that the risk of epilepsy is different depending on the subtype, with the APOE gene being more associated with temporal lobe epilepsy, drug-refractory epilepsy, and late-onset epilepsy. Patients with the ɛ4 allele have an earlier onset, worse cognition, and are more likely to have a history of febrile convulsion. No association between the ɛ4 allele and psychiatric symptoms and seizure-free after surgery.
Interpretation
These findings will help inform the provision of epilepsy services, including clinical management an important option for epilepsy patients with cognitive impairment, temporal lobe epilepsy, late-onset epilepsy, and drug-refractory epilepsy. However, whether APOE gene testing should be used as a routine test in people with epilepsy remains to be determined.
{"title":"The association between APOE gene polymorphisms and the risk, characteristics, and prognosis of epilepsy: A systematic review and meta-analysis","authors":"Shengyi Liu, Zihua He, Wenyan Shi, Jinmei Li","doi":"10.1016/j.yebeh.2024.110070","DOIUrl":"10.1016/j.yebeh.2024.110070","url":null,"abstract":"<div><h3>Objective</h3><div>Epilepsy is one of the most common neurological diseases. Current evidence suggests that the apolipoprotein E (APOE) gene may be related to epilepsy. The purpose was to explore whether the APOE gene is associated with the risk, characteristics, and prognosis of epilepsy.</div></div><div><h3>Methods</h3><div>The study was a systematic review and <em>meta</em>-analysis. We searched WANFANG, VIP, CNKI, Embase, CENTRAL, and Medline for relevant studies published in English and Chinese inception up to December 27, 2023. Studies containing both APOE genotypes or at least one type of APOE allele and epilepsy were included.</div></div><div><h3>Results</h3><div>A total of 46 studies were included. Fourteen studies reported APOE genotypes and epilepsy risk (2539 patients and 2847 controls). The <em>meta</em>-analyses showed that the APOE 4 was higher in epilepsy (OR [95 % CI] = 1.32 [1.07, 1.62], <em>I<sup>2</sup></em> = 30 %), the APOE 2 was lower in epilepsy (OR [95 % CI] = 0.73 [0.62, 0.87], <em>I<sup>2</sup></em> = 0 %), and the APOE 3 didn’t differ between epilepsy and controls (OR [95 % CI] = 1.01 [0.86, 1.19], <em>I<sup>2</sup></em> = 29 %). Our findings highlight that the risk of epilepsy is different depending on the subtype, with the APOE gene being more associated with temporal lobe epilepsy, drug-refractory epilepsy, and late-onset epilepsy. Patients with the ɛ4 allele have an earlier onset, worse cognition, and are more likely to have a history of febrile convulsion. No association between the ɛ<em>4</em> allele and psychiatric symptoms and seizure-free after surgery.</div></div><div><h3>Interpretation</h3><div>These findings will help inform the provision of epilepsy services, including clinical management an important option for epilepsy patients with cognitive impairment, temporal lobe epilepsy, late-onset epilepsy, and drug-refractory epilepsy. However, whether APOE gene testing should be used as a routine test in people with epilepsy remains to be determined.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.yebeh.2024.110083
Alain Braillon
{"title":"Cognitive outcomes after fetal exposure to antiseizure medications: Do we really care?","authors":"Alain Braillon","doi":"10.1016/j.yebeh.2024.110083","DOIUrl":"10.1016/j.yebeh.2024.110083","url":null,"abstract":"","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sudden Unexpected Death in Epilepsy (SUDEP) is a leading cause of mortality among people with epilepsy (PWE). Risk factors such as increased seizure frequency, drug-resistant epilepsy, and early epilepsy onset are well recognised. However, little evidence of the role of seizure severity, specifically Status Epilepticus (SE) on SUDEP risk exists.
Objective
To identify mechanisms, risk factors and clinical characteristics overlap between SE and SUDEP.
Methods
A scoping review using the PRISMA-ScR model was performed by two reviewers using suitable search terms. The PubMed Advanced Search tool along with the ancestry method was utilised to identify suitable articles published between 06/1992 and 05/2023. Quantitative, qualitative and mixed method studies were included. A narrative synthesis was undertaken and is presented as themes and subthemes.
Results
Of 5453 papers identified in the preliminary search, 50 studies were suitable for final analysis. Key themes include overlap between SE complications and SUDEP risk factors (pharmaco-resistant generalised tonic-clonic epilepsy, intellectual disability), overlap of shared risk factors (alcohol abuse, developmental epileptic encephalopathies) and clinical characteristics (cardiac and respiratory). SE’s role in development of drug-resistant epilepsy was the strongest potential mechanism for SE’s contribution to SUDEP risk. SE’s contribution to recurrent ictal hypoxaemia episodes and lowered heart rate variability suggests a relationship with SUDEP needing further study.
Conclusions
This review identifies research areas of influence of SE on SUDEP risk. Such research could inform counselling for patients concerned about seizure severity in relation to their SUDEP risk and optimise surveillance and subsequent management of post-SE epileptogenic outcomes.
背景：癫痫患者意外猝死（SUDEP）是导致癫痫患者死亡的主要原因。癫痫发作频率增加、耐药性癫痫和癫痫发病过早等风险因素已得到广泛认可。然而，几乎没有证据表明癫痫发作的严重程度，特别是癫痫状态（SE）对 SUDEP 风险的作用：目的：确定 SE 与 SUDEP 之间重叠的机制、风险因素和临床特征：方法：由两名审稿人使用合适的检索词，采用 PRISMA-ScR 模型进行范围界定审查。利用 PubMed 高级搜索工具和祖先法来识别 1992 年 6 月至 2023 年 5 月间发表的合适文章。其中包括定量、定性和混合方法研究。进行了叙述性综合，并以主题和次主题的形式呈现：在初步搜索确定的 5453 篇论文中，有 50 项研究适合进行最终分析。关键主题包括 SE 并发症与 SUDEP 危险因素（药物耐受性全身强直阵挛性癫痫、智力障碍）之间的重叠、共同危险因素（酗酒、发育性癫痫性脑病）和临床特征（心脏和呼吸系统）之间的重叠。SE在耐药性癫痫发展中的作用是SE导致SUDEP风险的最强有力的潜在机制。SE 对反复发作性低氧血症和心率变异性降低的作用表明，SE 与 SUDEP 的关系需要进一步研究：本综述确定了 SE 对 SUDEP 风险影响的研究领域。此类研究可为关注癫痫发作严重程度的患者提供与其 SUDEP 风险相关的咨询服务，并优化对 SE 后致痫结果的监测和后续管理。
{"title":"Status Epilepticus a risk factor for Sudden Unexpected Death in Epilepsy (SUDEP): A scoping review and narrative synthesis","authors":"Zygimantas Puras , Saffron Richardson , Lance Vincent Watkins , Rohit Shankar","doi":"10.1016/j.yebeh.2024.110085","DOIUrl":"10.1016/j.yebeh.2024.110085","url":null,"abstract":"<div><h3>Background</h3><div>Sudden Unexpected Death in Epilepsy (SUDEP) is a leading cause of mortality among people with epilepsy (PWE). Risk factors such as increased seizure frequency, drug-resistant epilepsy, and early epilepsy onset are well recognised. However, little evidence of the role of seizure severity, specifically Status Epilepticus (SE) on SUDEP risk exists.</div></div><div><h3>Objective</h3><div>To identify mechanisms, risk factors and clinical characteristics overlap between SE and SUDEP.</div></div><div><h3>Methods</h3><div>A scoping review using the PRISMA-ScR model was performed by two reviewers using suitable search terms. The PubMed Advanced Search tool along with the ancestry method was utilised to identify suitable articles published between 06/1992 and 05/2023. Quantitative, qualitative and mixed method studies were included. A narrative synthesis was undertaken and is presented as themes and subthemes.</div></div><div><h3>Results</h3><div>Of 5453 papers identified in the preliminary search, 50 studies were suitable for final analysis. Key themes include <em>overlap between SE complications and SUDEP risk factors</em> (pharmaco-resistant generalised tonic-clonic epilepsy, intellectual disability), <em>overlap of shared risk factors</em> (alcohol abuse, developmental epileptic encephalopathies) and <em>clinical characteristics</em> (cardiac and respiratory). SE’s role in development of drug-resistant epilepsy was the strongest potential mechanism for SE’s contribution to SUDEP risk. SE’s contribution to recurrent ictal hypoxaemia episodes and lowered heart rate variability suggests a relationship with SUDEP needing further study.</div></div><div><h3>Conclusions</h3><div>This review identifies research areas of influence of SE on SUDEP risk. Such research could inform counselling for patients concerned about seizure severity in relation to their SUDEP risk and optimise surveillance and subsequent management of post-SE epileptogenic outcomes.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.yebeh.2024.110068
Natasha E. Schoeler
Status epilepticus is a severe neurological condition, characterized by abnormally, prolonged seizures. Recent studies have explored the use of ketogenic diets (KDs) as a potential therapeutic approach for refractory status epilepticus. This article summarises the recent literature and discussions regarding the practicalities of implementing KDs in the critical care setting. This overview was presented at the 9th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in April 2024.
{"title":"The role of ketogenic diets in the treatment of status epilepticus","authors":"Natasha E. Schoeler","doi":"10.1016/j.yebeh.2024.110068","DOIUrl":"10.1016/j.yebeh.2024.110068","url":null,"abstract":"<div><div>Status epilepticus is a severe neurological condition, characterized by abnormally, prolonged seizures. Recent studies have explored the use of ketogenic diets (KDs) as a potential therapeutic approach for refractory status epilepticus. This article summarises the recent literature and discussions regarding the practicalities of implementing KDs in the critical care setting. This overview was presented at the 9th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in April 2024.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This review focusses on sudden unexpected death in epilepsy patients (SUDEP) and incorporates risk stratification (through SUDEP risk factors and SUDEP risk scores), hypotheses on the mechanism of SUDEP and eligible seizure detection devices (SDDs) for further SUDEP prevention studies.
The main risk factors for SUDEP are the presence and the frequency of generalized tonic-clonic seizures (GTC). In Swedish population-based case control study, the Odds ratio of the presence of GTC in the absence of bedroom sharing is 67.
SUDEP risk scoring systems express a score that represents the cumulative presence of SUDEP risk factors, but not the exact effect of their combination. We describe 4 of the available scoring systems: SUDEP-7 inventory, SUDEP-3 inventory, SUDEP-ClinicAl Risk scorE (SUDEP-CARE score) and Kempenhaeghe SUDEP risk score. Although they all include GTC, their design is often different. Three of 4 scoring systems were validated (SUDEP-7 inventory, SUDEP-3 inventory and SUDEP-CARE score). None of the available scoring systems has been sufficiently validated for the use in a general epilepsy population.
Plausible mechanisms of SUDEP are discussed. In the MORTEMUS-study (Mortality in Epilepsy Monitoring Unit Study), SUDEP was a postictal cardiorespiratory arrest after a GTC. The parallel respiratory and cardiac dysfunction in SUDEP suggests a central dysfunction of the brainstem centers that are involved in the control of respiration and heart rhythm. In the (consequent) adenosine serotonin hypotheses SUDEP occurs when a postictal adenosine-mediated respiratory depression is not compensated by the effect of serotonin. Other (adjuvant) mechanisms and factors are discussed.
Seizure detection devices (SDDs) may help to improve nocturnal supervision. Five SDDs have been validated in phase 3 studies for the detection of TC: Seizure Link®, Epi-Care®, NightWatch, Empatica, Nelli®. They have demonstrated a sensitivity of at least 90 % combined with an acceptable false positive alarm rate. It has not yet been proven that the use will actually lead to SUDEP prevention, but clinical experience supports their effectiveness.
{"title":"Update review on SUDEP: Risk assessment, background & seizure detection devices","authors":"C.P.J.A. Monté , J.B.A.M. Arends , R.H.C. Lazeron , I.Y. Tan , P.A.J.M. Boon","doi":"10.1016/j.yebeh.2024.109966","DOIUrl":"10.1016/j.yebeh.2024.109966","url":null,"abstract":"<div><div>This review focusses on sudden unexpected death in epilepsy patients (SUDEP) and incorporates risk stratification (through SUDEP risk factors and SUDEP risk scores), hypotheses on the mechanism of SUDEP and eligible seizure detection devices (SDDs) for further SUDEP prevention studies.</div><div>The main risk factors for SUDEP are the presence and the frequency of generalized tonic-clonic seizures (GTC). In Swedish population-based case control study, the Odds ratio of the presence of GTC in the absence of bedroom sharing is 67.</div><div>SUDEP risk scoring systems express a score that represents the cumulative presence of SUDEP risk factors, but not the exact effect of their combination. We describe 4 of the available scoring systems: SUDEP-7 inventory, SUDEP-3 inventory, SUDEP-ClinicAl Risk scorE (SUDEP-CARE score) and Kempenhaeghe SUDEP risk score. Although they all include GTC, their design is often different. Three of 4 scoring systems were validated (SUDEP-7 inventory, SUDEP-3 inventory and SUDEP-CARE score). None of the available scoring systems has been sufficiently validated for the use in a general epilepsy population.</div><div>Plausible mechanisms of SUDEP are discussed. In the MORTEMUS-study (Mortality in Epilepsy Monitoring Unit Study), SUDEP was a postictal cardiorespiratory arrest after a GTC. The parallel respiratory and cardiac dysfunction in SUDEP suggests a central dysfunction of the brainstem centers that are involved in the control of respiration and heart rhythm. In the (consequent) adenosine serotonin hypotheses SUDEP occurs when a postictal adenosine-mediated respiratory depression is not compensated by the effect of serotonin. Other (adjuvant) mechanisms and factors are discussed.</div><div>Seizure detection devices (SDDs) may help to improve nocturnal supervision. Five SDDs have been validated in phase 3 studies for the detection of TC: Seizure Link®, Epi-Care®, NightWatch, Empatica, Nelli®. They have demonstrated a sensitivity of at least 90 % combined with an acceptable false positive alarm rate. It has not yet been proven that the use will actually lead to SUDEP prevention, but clinical experience supports their effectiveness.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-28DOI: 10.1016/j.yebeh.2024.110036
Elizabeth I. Harrison , Traci M. Kazmerski , Harry S. Hochheiser , Yoshimi Sogawa , Laura A. Kirkpatrick
Rationale.
Young people with epilepsy of childbearing potential (YPWECP) are vulnerable to a variety of adverse health outcomes due to teratogenic antiseizure medications (ASMs) and drug-drug interactions between ASMs and contraceptives that can lead to breakthrough seizures and/or contraceptive failure. To better understand reproductive healthcare provision for YPWECP, we conducted a retrospective analysis of relevant prescription patterns.
Methods
We analyzed procedural and medication data for YPWECP ages 13–21 years (n = 1525) from 2011 through 2021 at a single tertiary-care pediatric medical center to investigate rates of (1) prescription of folic acid, (2) prescription of an enzyme-inducing ASM<6 months before or after hormonal contraception initiation (or < 3 years after subdermal implant placement), (3) prescription of lamotrigine < 6 months before or after an estrogen-containing contraceptive that could affect lamotrigine serum concentrations, and (4) documentation of any contraceptive medication or device that overlaps initiation of a patient’s first teratogenic ASM. We performed statistical analyses with sample proportion z-tests. We then used logistic regression and generalized estimating equations to evaluate for associations between patient characteristics and prescription patterns.
Results
Among 1525 YPWECP, less than half (41 %, n = 629) were prescribed folic acid during the study period (95 % CI 38.8–43.7). Of YPWECP prescribed an enzyme-inducing ASM, 24 % (186/766) were co-prescribed a hormonal contraceptive that adversely interacts with the ASM (95 % CI 21.2–27.3 %). Of those prescribed lamotrigine during the study period, 24 % (111/472) had documentation of an estrogen-containing medication that could affect lamotrigine serum concentrations < 6 months before or after that prescription (95 % CI 19.7–27.3 %). Of those prescribed a teratogenic ASM, only 13 % (82/638) had documentation of contraception prior to (or within the same month as) starting their first teratogenic ASM (95 % CI 10.3–15.5 %). Older age was associated with increased odds of contraceptive coverage prior to initiation of the first teratogenic ASM and was also associated with increased odds of having contraceptives co-prescribed with ASMs that could interact. No significant associations were found between race/ethnicity and any outcomes.
Conclusions
YPWECP experience low rates of folic acid prescription and low rates of contraceptive coverage while prescribed teratogenic ASMs. Many YPWECP, particularly older adolescents, are at increased risk for contraceptive failure and/or breakthrough seizures due to drug-drug interactions. Results demonstrate a need for increased focus on reproductive healthcare for YPWECP. Future studies should evaluate interventions aimed at improving these outcomes.
{"title":"Prescription patterns relevant to young people with epilepsy of childbearing potential","authors":"Elizabeth I. Harrison , Traci M. Kazmerski , Harry S. Hochheiser , Yoshimi Sogawa , Laura A. Kirkpatrick","doi":"10.1016/j.yebeh.2024.110036","DOIUrl":"10.1016/j.yebeh.2024.110036","url":null,"abstract":"<div><div>Rationale.</div><div>Young people with epilepsy of childbearing potential (YPWECP) are vulnerable to a variety of adverse health outcomes due to teratogenic antiseizure medications (ASMs) and drug-drug interactions between ASMs and contraceptives that can lead to breakthrough seizures and/or contraceptive failure. To better understand reproductive healthcare provision for YPWECP, we conducted a retrospective analysis of relevant prescription patterns.</div></div><div><h3>Methods</h3><div>We analyzed procedural and medication data for YPWECP ages 13–21 years (n = 1525) from 2011 through 2021 at a single tertiary-care pediatric medical center to investigate rates of (1) prescription of folic acid, (2) prescription of an enzyme-inducing ASM<6 months before or after hormonal contraception initiation (or < 3 years after subdermal implant placement), (3) prescription of lamotrigine < 6 months before or after an estrogen-containing contraceptive that could affect lamotrigine serum concentrations, and (4) documentation of any contraceptive medication or device that overlaps initiation of a patient’s first teratogenic ASM. We performed statistical analyses with sample proportion z-tests. We then used logistic regression and generalized estimating equations to evaluate for associations between patient characteristics and prescription patterns.</div></div><div><h3>Results</h3><div>Among 1525 YPWECP, less than half (41 %, n = 629) were prescribed folic acid during the study period (95 % CI 38.8–43.7). Of YPWECP prescribed an enzyme-inducing ASM, 24 % (186/766) were co-prescribed a hormonal contraceptive that adversely interacts with the ASM (95 % CI 21.2–27.3 %). Of those prescribed lamotrigine during the study period, 24 % (111/472) had documentation of an estrogen-containing medication that could affect lamotrigine serum concentrations < 6 months before or after that prescription (95 % CI 19.7–27.3 %). Of those prescribed a teratogenic ASM, only 13 % (82/638) had documentation of contraception prior to (or within the same month as) starting their first teratogenic ASM (95 % CI 10.3–15.5 %). Older age was associated with increased odds of contraceptive coverage prior to initiation of the first teratogenic ASM and was also associated with increased odds of having contraceptives co-prescribed with ASMs that could interact. No significant associations were found between race/ethnicity and any outcomes.</div></div><div><h3>Conclusions</h3><div>YPWECP experience low rates of folic acid prescription and low rates of contraceptive coverage while prescribed teratogenic ASMs. Many YPWECP, particularly older adolescents, are at increased risk for contraceptive failure and/or breakthrough seizures due to drug-drug interactions. Results demonstrate a need for increased focus on reproductive healthcare for YPWECP. Future studies should evaluate interventions aimed at improving these outcomes.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-25DOI: 10.1016/j.yebeh.2024.110064
Anjiao Peng , Yike Zhou , Zhu Liu , Shuming Ji , Yusha Tang , Hua Li , Lei Chen
Objective
This study aimed to investigate whether folic acid supplementation at normal or high doses could reduce major congenital malformations and improve neurodevelopment in the offspring of women with epilepsy (WWE).
Methods
The MEDLINE, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov databases were searched for observational studies reporting pregnancy outcomes and information about folic acid supplementation in WWE, with a cut-off date of December 5, 2023. Data extraction and synthesis were performed in accordance with the PRISMA guidelines. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted to obtain pooled odds ratios (ORs) and 95% confidence intervals (CI), to estimate the effect of periconceptional folic acid supplementation on pregnancy outcomes in WWE. Sensitivity analyses including only studies with WWE who took anti-seizure medications during pregnancy or studies with a sample size greater than 100 were further performed. This study was registered in PROSPEROID (no. CRD42019141820).
Results
The database search yielded 23 eligible articles. Unexpectedly, the results of subsequent meta-analysis showed that the risk of major congenital malformations was relatively higher in those with periconceptional folic acid supplementation (17463 pregnancies, OR, 1.34; 95 %CI, 1.12–1.6), and was similar between those with and without folic acid supplementation ≧ 4 mg (3822 pregnancies, OR, 0.9; 95 %CI, 0.65–1.24). Results showed that periconceptional folic acid supplementation may be beneficial for neurodevelopment but the evidence was limited.
Conclusions
This systematic review showed no evidence of a beneficial effect of folic acid supplementation in reducing the risk of major congenital malformations, while the relative risk was slightly higher in those receiving periconceptional folic acid supplementation. Nevertheless, folic acid supplementation may improve neurobehavioral outcomes.
方法在MEDLINE、EMBASE、Web of Science、Cochrane Library和ClinicalTrials.gov数据库中检索报告妊娠结局的观察性研究以及有关WWE叶酸补充的信息，截止日期为2023年12月5日。数据提取和综合按照 PRISMA 指南进行。研究的方法学质量采用纽卡斯尔-渥太华量表进行评估。采用随机效应荟萃分析法得出汇总的几率比（ORs）和95%置信区间（CI），以估计围孕期补充叶酸对WWE妊娠结局的影响。敏感性分析仅包括孕期服用抗癫痫药物的 WWE 或样本量大于 100 的研究。本研究已在 PROSPEROID（编号：CRD42019141820）上注册。意外的是，随后的荟萃分析结果显示，围孕期补充叶酸的孕妇发生重大先天性畸形的风险相对较高（17463 例妊娠，OR，1.34；95 %CI，1.12-1.6），而叶酸补充量大于 4 mg 的孕妇和未补充叶酸的孕妇发生重大先天性畸形的风险相似（3822 例妊娠，OR，0.9；95 %CI，0.65-1.24）。结果表明，围孕期补充叶酸可能对神经发育有益，但证据有限。结论该系统综述显示，没有证据表明补充叶酸对降低重大先天性畸形的风险有益，而围孕期补充叶酸的孕妇相对风险略高。不过，补充叶酸可能会改善神经行为的结果。
{"title":"Periconceptional folic acid supplementation for women with epilepsy: A systematic review of the literature","authors":"Anjiao Peng , Yike Zhou , Zhu Liu , Shuming Ji , Yusha Tang , Hua Li , Lei Chen","doi":"10.1016/j.yebeh.2024.110064","DOIUrl":"10.1016/j.yebeh.2024.110064","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate whether folic acid supplementation at normal or high doses could reduce major congenital malformations and improve neurodevelopment in the offspring of women with epilepsy (WWE).</div></div><div><h3>Methods</h3><div>The MEDLINE, EMBASE, Web of Science, Cochrane Library, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> databases were searched for observational studies reporting pregnancy outcomes and information about folic acid supplementation in WWE, with a cut-off date of December 5, 2023. Data extraction and synthesis were performed in accordance with the PRISMA guidelines. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. A random-effects <em>meta</em>-analysis was conducted to obtain pooled odds ratios (ORs) and 95% confidence intervals (CI), to estimate the effect of periconceptional folic acid supplementation on pregnancy outcomes in WWE. Sensitivity analyses including only studies with WWE who took anti-seizure medications during pregnancy or studies with a sample size greater than 100 were further performed. This study was registered in PROSPEROID (no. CRD42019141820).</div></div><div><h3>Results</h3><div>The database search yielded 23 eligible articles. Unexpectedly, the results of subsequent <em>meta</em>-analysis showed that the risk of major congenital malformations was relatively higher in those with periconceptional folic acid supplementation (17463 pregnancies, OR, 1.34; 95 %CI, 1.12–1.6), and was similar between those with and without folic acid supplementation ≧ 4 mg (3822 pregnancies, OR, 0.9; 95 %CI, 0.65–1.24). Results showed that periconceptional folic acid supplementation may be beneficial for neurodevelopment but the evidence was limited.</div></div><div><h3>Conclusions</h3><div>This systematic review showed no evidence of a beneficial effect of folic acid supplementation in reducing the risk of major congenital malformations, while the relative risk was slightly higher in those receiving periconceptional folic acid supplementation. Nevertheless, folic acid supplementation may improve neurobehavioral outcomes.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.yebeh.2024.110062
Chris L. Peterson , Christine Walker
A number of studies have been conducted on the effects of the COVID-19 pandemic on people with epilepsy (PWE), some showing increased seizures, poorer psychosocial states, and reductions in Quality of Life (QoL). During the latter stages of COVID-19, well before the UN declared an end to the state of emergency, our study was conducted in Australia of a sample of women and men ≥ 18 years. The study was based on Wave 6 of the Australian Epilepsy Longitudinal Study (AELS). It used mixed methods. Two main scales were used in the study, the QOLIE-31 for QoL and the MOS-8 for social support. The quantitative component of the study looked at QoL in relation to COVID-19 and found no QoL differences in those who contracted the virus. However, there was significantly lower QoL in those having difficulties in seeing a GP, for those with limited access to healthcare, and for those who had problems in gaining ASMs (anti-seizure medicines) and/or other medicines and being unvaccinated. Being younger and living in rental accommodation were most likely significant contributing factors. Those not being vaccinated were less than the proportion in the whole national population., The qualitative component focussed on reasons for being vaccinated or not. Overall, the responses to the question “Were you vaccinated?” demonstrated that people made informed decisions on vaccinations, taking into account their own health as well as protecting family and public health considerations.
{"title":"Experiences of COVID-19 in an Australian community cohort of adults with epilepsy","authors":"Chris L. Peterson , Christine Walker","doi":"10.1016/j.yebeh.2024.110062","DOIUrl":"10.1016/j.yebeh.2024.110062","url":null,"abstract":"<div><div>A number of studies have been conducted on the effects of the COVID-19 pandemic on people with epilepsy (PWE), some showing increased seizures, poorer psychosocial states, and reductions in Quality of Life (QoL). During the latter stages of COVID-19, well before the UN declared an end to the state of emergency, our study was conducted in Australia of a sample of women and men ≥ 18 years. The study was based on Wave 6 of the Australian Epilepsy Longitudinal Study (AELS). It used mixed methods. Two main scales were used in the study, the QOLIE-31 for QoL and the MOS-8 for social support. The quantitative component of the study looked at QoL in relation to COVID-19 and found no QoL differences in those who contracted the virus. However, there was significantly lower QoL in those having difficulties in seeing a GP, for those with limited access to healthcare, and for those who had problems in gaining ASMs (anti-seizure medicines) and/or other medicines and being unvaccinated. Being younger and living in rental accommodation were most likely significant contributing factors. Those not being vaccinated were less than the proportion in the whole national population., The qualitative component focussed on reasons for being vaccinated or not. Overall, the responses to the question “Were you vaccinated?” demonstrated that people made informed decisions on vaccinations, taking into account their own health as well as protecting family and public health considerations.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S152550502400444X/pdfft?md5=3a1f11cfda83e3a2a739c4c3c2569767&pid=1-s2.0-S152550502400444X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.yebeh.2024.110057
Kelly T. Macdonald, Chloe A. Hooker, Hayley J. Loblein, William Davis Gaillard, Leigh N. Sepeta, Madison M. Berl
This study evaluated the profile of language and reading skills among children with epilepsy. We utilized a sample of children from an epilepsy database who were administered a measure of reading comprehension, excluding those whose intellectual skills were in the impaired range (N=147; age range 4–20 years, 52 % female). Additional measures that were considered within the sample included broad language skills, pre-reading skills (phonological processing, rapid naming, decoding), and basic reading skills (sight word reading, reading fluency). We further considered associations between these skills and seizure characteristics (age of onset, number of anti-seizure medications, seizure type, seizure frequency, and localization). We found that our sample performed significantly lower on all language and reading skills, on average, than normative expectations. Within our sample, relative strengths were noted in broad language skills, and relative weaknesses were found in phonological processing, rapid naming, reading fluency, word reading, and reading comprehension. We further identified a subgroup of our sample (31 %) who were characterized as struggling in reading comprehension (performing one standard deviation below the normative mean); these children exhibited a profile more consistent with non-epilepsy samples with reading disabilities/ dyslexia. Seizure variables that were associated with language and reading skills included age of onset, number of anti-seizure medications, seizure frequency, and having generalized (versus focal) seizures. These results have important implications for the identification and treatment of reading problems in children with epilepsy.
{"title":"Reading and language profiles among children with epilepsy","authors":"Kelly T. Macdonald, Chloe A. Hooker, Hayley J. Loblein, William Davis Gaillard, Leigh N. Sepeta, Madison M. Berl","doi":"10.1016/j.yebeh.2024.110057","DOIUrl":"10.1016/j.yebeh.2024.110057","url":null,"abstract":"<div><div>This study evaluated the profile of language and reading skills among children with epilepsy. We utilized a sample of children from an epilepsy database who were administered a measure of reading comprehension, excluding those whose intellectual skills were in the impaired range (N=147; age range 4–20 years, 52 % female). Additional measures that were considered within the sample included broad language skills, pre-reading skills (phonological processing, rapid naming, decoding), and basic reading skills (sight word reading, reading fluency). We further considered associations between these skills and seizure characteristics (age of onset, number of anti-seizure medications, seizure type, seizure frequency, and localization). We found that our sample performed significantly lower on all language and reading skills, on average, than normative expectations. Within our sample, relative strengths were noted in broad language skills, and relative weaknesses were found in phonological processing, rapid naming, reading fluency, word reading, and reading comprehension. We further identified a subgroup of our sample (31 %) who were characterized as struggling in reading comprehension (performing one standard deviation below the normative mean); these children exhibited a profile more consistent with non-epilepsy samples with reading disabilities/ dyslexia. Seizure variables that were associated with language and reading skills included age of onset, number of anti-seizure medications, seizure frequency, and having generalized (versus focal) seizures. These results have important implications for the identification and treatment of reading problems in children with epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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