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5 results

  • Chapter 10 - Contraception and Prepregnancy Counseling

  • Edited by Esther Bui, Toronto Western Hospital, P. Emanuela Voinescu, Brigham & Women's Hospital, Boston, MA
  • Book:
    Women with Epilepsy
    Published online:
    19 December 2024
    Print publication:
    02 January 2025, pp 168-190

  • Summary

    Enzyme-inducing antiepileptic drugs (EI-ASMs) such as phenytoin, carbamazepine, oxcarbazepine, and phenobarbital may decrease contraceptive efficacy. When considering contraception for women with epilepsy (WWE), the intrauterine device (IUD) is a first line choice. It is important to keep in mind that hormonal contraception with estrogenic components induces the metabolism of lamotriginePreconception counseling should be started early and revisited frequently for WWE of childbearing age. Pre-partum optimization of ASMs ideally should be done 9−12 months before a planned pregnancy. The majority of WWE are likely to have a safe pregnancy and a healthy newborn.

Management of Seizures in Neurosurgical Practice

Management of Seizures in Neurosurgical Practice
  • Julie Woodfield, Susan Duncan
  • Published online:
    13 April 2024
    Print publication:
    09 May 2024
  • Seizures are a presenting feature of many neurosurgical disorders, and can arise as a result of neurosurgical treatment or its complications. Recognition and effective management of seizures can be life-saving, and will minimise long term seizure induced morbidity. In this Element the authors describe seizure diagnosis, emergency and ongoing management, and considerations in neurosurgical conditions.

  • The North American Antiepileptic Drug Pregnancy Registry: A Canadian Subgroup Analysis

  • Julien Hébert, Susan N. Conant, Lewis B. Holmes, Esther Bui
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 50 / Issue 2 / March 2023
    Published online by Cambridge University Press:
    13 January 2022, pp. 214-220
    • Article
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  • Background:

    The North American AED Pregnancy Registry (NAAPR) provides crucial data for understanding the risks of antiepileptic drug (AED) exposure in pregnancy. This study aims to quantify the Canadian contribution to NAAPR and compare AED usage in pregnancy in Canada and the USA.

    Methods:

    Enrollment rate ratios (ERR) to NAAPR, adjusted for the populations of women of childbearing age, were calculated for the USA, Canada, and for the different Canadian provinces. Methods of enrollment to NAAPR and AED usage were compared between the two countries using chi-squared tests.

    Results:

    Between 1997 and 2019, 10,215 pregnant women enrolled into NAAPR: 4.1% were Canadian (n = 432, ERR = 0.39, CI95% = 0.35–0.43). Within Canada, no patients were enrolled from the three northern territories or from Prince Edward Island. While fewer patients than expected enrolled from Quebec (ERR = 0.35, CI95% = 0.19–0.58), Nova Scotia had the highest enrollment rate (ERR = 1.55; CI95% = 0.66–3.11). Compared with their American peers, Canadians were less likely to have been enrolled by their healthcare provider and more likely to have been enrolled via social media (p < 0.01). Canadian women were more likely to be taking carbamazepine (24% vs. 15%; p < 0.01) or valproic acid (8% vs. 4%; p < 0.01).

    Conclusion:

    The proportion of Canadian enrollees into NAAPR was less than expected based on the relative population size of Canadian women of reproductive age. Greater Canadian enrollment to NAAPR would contribute to ongoing worldwide efforts in assessing the risks of AEDs use in pregnant women and help quantify rates of AED usage, major congenital malformations, and access to subspecialized epilepsy care within Canada.

  • Epilepsy in older people

  • Nicola Smith, Divya Tiwari
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 1 / February 2015
    Published online by Cambridge University Press:
    13 April 2015, pp. 53-59
    Print publication:
    February 2015

  • Epilepsy is the third most common neurological disorder of older adults, with huge functional and psychological implications. It is often difficult to diagnose in the presence of cognitive impairment and lack of a witness account. The most common identifiable causes of epilepsy in old age are cerebrovascular disease and dementia. New guidelines recommend starting treatment after first unprovoked seizure. If there is any doubt about the diagnosis, electroencephalography (EEG) should be considered, or ‘wait and watch’. The aim of treatment should be to fully control seizure activity with the most effective monotherapy and fewest possible side-effects. Drug compliance is often difficult to achieve in older adults.

  • Improvement in Speeded Cognitive Processing After Anti-epileptic Drug Withdrawal – A Controlled Study in Mono-therapy Patients

  • Erik Hessen, Morten I. Lossius, Ivar Reinvang, Leif Gjerstad
  • Journal:
    Progress in Neurotherapeutics and Neuropsychopharmacology / Volume 3 / Issue 1 / January 2008
    Published online by Cambridge University Press:
    12 December 2007, pp. 199-209
    Print publication:
    January 2008

  • ABSTRACT

    Background: Anti-epileptic drugs (AEDs) are associated with cognitive side effects. Doubt exists regarding the degree of cognitive effects primarily related to problems with design and methodology in many studies. The aim of the reported study was to assess the effect of AED withdrawal in patients on monotherapy using computerised measures of attention, reaction time and speed of information processing. Methods: One hundred and fifty patients seizure free >2 years on drug monotherapy went through a randomised, double blind, placebo controlled study. All patients were included for 12 months or until seizure relapse. Cognitive function was assessed with the California Computerized Assessment Package at baseline and 7 months after withdrawal. Results: The major finding was that discontinuation of major AEDs significantly improved performance on tests that require complex cognitive processing under time pressure. The difference in speed of cognitive processing between the withdrawal and non-withdrawal groups was between 24 and 43 ms. No significant difference emerged between the groups on simple tasks of attention and reaction time. Most of the patients in the study were treated with carbamazepine and valproate. The outcome of carbamazepine withdrawal was similar to the outcome for the total study population while discontinuation of valproate only revealed a non-significant tendency in the same direction. Interpretation: The results suggest that seizure-free epilepsy patients on monotherapy can obtain improvement in speeded cognitive processing if they withdraw anti-epileptic treatment.