Women living with epilepsy, experiences of pregnancy and reproductive health: a review of the literature

Lost in the System: Responsibilisation and Burden for Women With Multiple Long-Term Health Conditions During Pregnancy

INTRODUCTION

Over a fifth of pregnant women are living with multiple long-term health conditions, which is associated with increased risks of adverse outcomes for mothers and infants. While there are many examples of research exploring individuals' experiences and care pathways for pregnancy with a single health condition, evidence relating to multiple health conditions is limited. This study aimed to explore experiences and care of women with multiple long-term health conditions around the time of pregnancy.

METHODS

Semistructured interviews were conducted between March 2022 and May 2023 with women with multiple long-term health conditions who were at least 28 weeks pregnant or had had a baby in the last 2 years, and healthcare professionals with experience of caring for these women. Participants were recruited from across the United Kingdom. Data were analysed using thematic analysis.

RESULTS

Fifty-seven women and 51 healthcare professionals participated. Five themes were identified. Women with long-term health conditions and professionals recognised that it takes a team to avoid inconsistent care and communication, for example, medication management. Often, women were required to take a care navigation role to link up their healthcare providers. Women described mixed experiences regarding care for their multiple identities and the whole person. Postnatally, women and professionals recognised a downgrade in care, particularly for women's long-term health conditions. Some professionals detailed the importance of engaging with women's knowledge, and recognising their own professional boundaries of expertise. Many participants described difficulties in providing informational continuity and subsequent impacts on care. Specifically, the setup of care systems made it difficult for everyone to access necessary information, especially when care involved multiple sites.

CONCLUSION

Pregnant women with long-term health conditions can experience a substantial burden of responsibility to maintain communication with their care team, often feeling vulnerable, patronised, and let down by a lack of acknowledgement of their expertise. These results will be used to inform the content of coproduction workshops aimed at developing a list of care recommendations for affected women. It will also inform future interventional studies aimed at improving outcomes for these women and their babies.

PATIENT OR PUBLIC CONTRIBUTION

Our Patient and Public Involvement group were involved in the design of the study and the analysis and interpretation of the data, and a public study investigator was part of the author group.

Investigation of illness perception and pregnancy avoidance in sexually active women with epilepsy

AIM

The aim of the study was to examine the perception of illness and avoidance of pregnancy in sexually active women with epilepsy.

METHODS

This study was completed with 82 women with epilepsy who were sexually active and who were admitted to the neurology clinic and outpatient clinic between June and September 2022. The descriptive information form, Brief Illness Perception Questionnaire (IPQ-B), and Pregnancy Avoidance Scale (PAS) were used to collect the data.

RESULTS

The mean age of the patients in the study was 32.96 ± 5.92 years and the mean disease duration was 11.19 ± 7.46 years. Among the patients, 75.6% had previous pregnancies, 70.7% did not have miscarriage or abortion, 69.5% previously gave birth, 61% used a contraceptive method (condom, intrauterine device (IUD), pills, etc.) in their last sexual intercourse, 52.4% had good communication with their spouses, 20% had two children, 51.2% had three or more seizures, and 86.6% used antiseizure medications (ASMs). The mean PAS score of the patients was 2.31 ± 1.14 and the mean IPQ-B score was 35.10 ± 13.16. The regression analysis found that the perception of illness was a significant positive predictor of avoidance of pregnancy and explained 17% of it.

CONCLUSION

Women with epilepsy avoided pregnancy and had negative illness perceptions. Moreover, negative illness perception increased pregnancy avoidance in women with epilepsy.

Comparative analysis of three decades' experience in the management of pregnant women with epilepsy: a real-life scenario

Introduction

People with epilepsy have to face many challenges, including regular follow-ups, the need to take antiseizure medications (ASMs), and the fear of seizures. Pregnant women with epilepsy (PWWE) are a special group with even more challenges because they are responsible for the fetus. We aimed to evaluate the change in the frequency of pregnancies over the years and the possible role of newer types of ASMs concerning this change, the shift in medication use over three decades, and their possible impact on the outcome of the observed pregnancies.

Methods

Data were retrieved from the prospective Epilepsy Database of the Outpatient Clinic at our tertiary center between 1 January 1992 and 31 December 2020. Groups were formed for comparison in time and depending on whether regular care consultation was our task. Statistical analysis was carried out using Microsoft Office Excel 2021. Basic statistics and categorical variables were assessed using Pearson's χ2 test with Yates' correction. Differences were considered significant if the p-value was <0.05. The odds ratio and 95% confidence intervals were calculated wherever needed.

Results

Altogether, 181 pregnancies were studied, mostly after 2002. The regular follow-up group consisted of 101 patients, with 44.5% presenting in the first trimester. The majority of seizures were either generalized or focal to bilateral tonic-clonic seizure types (85.6%). Pregnancies ended in live births in 91.7%, which gradually improved over time, while spontaneous abortion did not differ significantly in the time interval groups. Mostly, monotherapy was provided. PWWEs had higher chances for seizure freedom in the regular-care group I: OR = 2.9 (2.15-3.65) p < 0.0001. A shift toward newer-type ASMs was found as time passed. Levetiracetam and lamotrigine were more commonly used in the regular care group I than by those patients who were sent to consultation only and not treated at our center [OR = 3.18 (2.49-3.87)] p < 0.0001.

Conclusion

This is the first study in our region to evaluate experience in the treatment and outcome of PWWE. Having received reliable care and safer ASMs, the number of pregnancies among PWWEs grew. Data suggested that specialized centers' care offered cooperation with obstetricians is important. Moreover, professional care can also enable PWWEs to have uneventful pregnancies.

Targeting adverse effects of antiseizure medication on offspring: current evidence and new strategies for safety

INTRODUCTION

For women with epilepsy of reproductive age, antiseizure medications (ASMs) are associated with an increased risk of offspring malformations. There are safety concerns for most anti-seizure medications in the perinatal period, and there is a clear need to identify safe medications. ASMs must transport through biological barriers to exert toxic effects on the fetus, and transporters play essential roles in trans-barrier drug transport. Therefore, it is vital to understand the distribution and properties of ASM-related transporters in biological barriers.

AREAS COVERED

This study reviews the structure, transporter distribution, and properties of the blood-brain, placental, and blood-milk barrier, and summarizes the existing evidence for the trans-barrier transport mechanism of ASMs and standard experimental models of biological barriers.

EXPERT OPINION

Ideal ASMs in the perinatal period should have the following characteristics: 1) Increased transport through the blood-brain barrier, and 2) Reduced transport of the placental and blood-milk barriers. Thus, only low-dose or almost no antiseizure medication could enter the fetus's body, which could decrease medication-induced fetal abnormalities. Based on the stimulated structure and molecular docking, we propose a development strategy for new ASMs targeting transporters of biological barriers to improve the perinatal treatment of female patients with epilepsy.

Monitored but not sufficiently guided - A qualitative descriptive interview study of maternity care experiences and needs in women with chronic medical conditions

OBJECTIVE

To explore maternity care experiences and needs of women with various types of chronic medical conditions receiving specialised maternity care. Design A qualitative descriptive study.

SETTING

A highly specialised hospital providing maternity care to women with high-risk pregnancies in Copenhagen, Denmark. Participants Fourteen purposefully selected women referred to specialist maternity care at a large tertiary hospital due to one or more chronic medical conditions.

METHODS

Individual in-depth interviews (n = 14) were performed between January 2018 and June 2019. Analysed using thematic analysis.

RESULTS

One overarching theme was identified: Monitored but not sufficiently guided. Three main themes unfolding this overarching theme were: Chronic condition as determining pregnancy care, Childbearing woman as messenger and interpreter, and Feelings of abandonment after giving birth.

KEY CONCLUSIONS

Across various types of chronic medical conditions, women expressed a need for increased continuity in specialised maternity care. Healthcare professionals should help women with chronic medical conditions navigate the healthcare system and interpret complex information.

IMPLICATIONS FOR PRACTICE

Pregnancy should be recognised as a significant life event, even though the childbearing woman is living with a chronic medical condition, and professionals should emphasise the aspects of pregnancy that develop uncomplicated. Information about the anticipated development of chronic medical conditions postpartum and concerns regarding breastfeeding could preferably be addressed during pregnancy. Continuity of care was particularly important to the women and could relieve some of the worrying women experienced during pregnancy.

Exploring the use of health and wellbeing measures during pregnancy and the first year following birth in women living with pre-existing long-term conditions: qualitative interviews with women and healthcare professionals

BACKGROUND

One way in which care for pregnant and postpartum women living with long-term health conditions (LTCs) may be improved is through the adoption of standardised measures to provide evidence of health outcomes and wellbeing from the woman's perspective.

AIM

The study explores the views of pregnant and postpartum women living with LTCs, and healthcare professionals to better understand the potential value of using standardised health and wellbeing measures within this patient population.

METHODS

Qualitative semi-structured telephone interviews were conducted to explore the perceived value of using measures with pregnant and postpartum women living with LTCs within maternity services. Participants were asked to provide feedback on three exemplar measures: the Long Term Conditions Questionnaire, the Wellbeing in Pregnancy Questionnaire and the EuroQol EQ-5D-5L instrument. Thematic analysis was used in the analysis of the transcripts.

RESULTS

Eleven women and 11 healthcare professionals took part in semi-structured interviews. Analysis identified five themes as relevant to the use of measures within maternity services: 1) Improving care, 2) Assessing outcomes, 3) Interpretation and application of data, 4) Engagement challenges and implementation and, 5) Women and healthcare professionals alignment.

CONCLUSIONS

Despite varying prior experience and expressing some questions about implementation, respondents were cautiously positive about the use of standardised health and wellbeing measures. Their use offers the opportunity for both affected women and healthcare professionals caring for them to collectively identify and assess important areas of unmet needs and improve outcomes. Incorporating the perspectives of women with LTC's will help bring awareness to elements of women centred care which health services may seek to address.

Well-being of mothers with epilepsy with school-aged children

PURPOSE

The purpose of the study was to examine different aspects of well-being in mothers with epilepsy with school-aged children.

METHODS

In an observational study, mothers, identified from the European Registry of Antiepileptic Drugs and Pregnancy database in the Netherlands, completed questions on epilepsy, the impact of epilepsy on daily functioning, quality of life, behavioral problems, and parenting stress. Descriptive analyses were performed to examine the prevalence of behavioral problems and the impact of epilepsy on different aspects of the mother's daily functioning and family life. We subsequently investigated which factors contributed most to the impact of maternal epilepsy using regression analyses.

RESULTS

One hundred fifty-six (46%) of the 342 invited mothers with epilepsy participated. The majority (89%) had low epilepsy severity, with well-controlled seizures. Internalizing problems within the borderline or clinical range were reported by 23% of the mothers. Behavioral problems were significantly correlated with epilepsy severity (r = 0.26, p = .002), impact of epilepsy on daily functioning (r = 0.32, p < .001), and quality of life (r = -0.52, p < 01). Quality of life was in general good (mean = 8, standard deviation [SD] = 1), with low impact of epilepsy. Epilepsy affected mostly maternal self-confidence, work, and general health. Mothers indicated to experience no to little impact of epilepsy on the relationship with their children, partner, or family. Regression analyses showed that epilepsy severity (1.0, 95% confidence interval [CI]: 0.4 to 1.6; p = .002) and quality of life (-1.3, CI: -2.3 to -0.4; p = .007) were significant contributors to the impact of epilepsy on daily functioning, while other factors (maternal education, family type, behavioral problems, and parenting stress) were nonsignificant.

DISCUSSION

The current study shows that mothers with epilepsy generally fared well. Epilepsy negatively impacted the lives of some mothers, though. As maternal well-being is of importance for mother-child interaction and child development, clinicians should be aware of the impact of epilepsy on maternal psychosocial outcomes and family life of women with epilepsy.

Reducing risks for pregnant women with epilepsy: A qualitative study exploring experiences of using a toolkit at the antenatal booking appointment

PURPOSE

Epilepsy is a high risk neurological disease associated with an increased risk of indirect maternal mortality due to sudden unexpected death in epilepsy. No evidence exists on the antenatal booking risk management process in women with epilepsy. This study therefore aimed to explore the experiences of midwives' in using a maternity epilepsy toolkit designed by the author to assist with this process. Midwives were chosen as the sample as they are predominantly the first health professional to learn of the diagnosis at the antenatal booking appointment.

OBJECTIVES

The objective of this study was to explore the experiences of midwives in using a maternity epilepsy toolkit at the booking appointment.

DESIGN

This is a qualitative study using the principles of hermeneutic phenomenology.

SETTING

The study setting is in One National Health Service (NHS) Trust in the South of England.

PARTICIPANTS

The participants of the study were n = 4 community midwives who used the maternity epilepsy toolkit at the booking appointment.

METHOD

In-depth semistructured one-to-one interviews were used.

MEASUREMENTS

An interview schedule using main questions, probes, and reinforcers was implemented. Audio-recorded interviews were transcribed verbatim. Transcripts were checked against audio recordings for accuracy.

ANALYSIS

Inductive approach organized by phenomenological framework to identify recurrent codes, patterns, and themes were used for analysis.

FINDINGS

The following three themes clearly emerged: 'foundations of epilepsy knowledge', 'using the toolkit in midwifery practice', and 'the toolkits influence on learning'.

CONCLUSION

Participants described lack of epilepsy knowledge and experience prior to using the 'toolkit' and how being prepared optimized its use. They articulated how it enabled them to collate the epilepsy and treatment history, share risk management strategies, and expedite referrals appropriately. They discussed how it increased confidence, reduced fear, and inspired motivation toward learning. The results of this study will provide a foundation for future research exploring the impact that the 'toolkit' has on multidisciplinary care provision.

IMPLICATIONS FOR PRACTICE

This small study demonstrated the 'toolkits' potential as a method of increasing knowledge about epilepsy and risk management. Initiation of its use in early pregnancy is intended to promote effective history taking, facilitate the identification of women at increased risk of morbidity and mortality, and encourage joint working through early multidisciplinary team referral and involvement. This paper is for the Special Issue :Prevent 21: SUDEP Summit - Time to Listen.

Efficacy of a midwife-coordinated, individualized, and specialized maternity care intervention (ChroPreg) in addition to standard care in pregnant women with chronic disease: protocol for a parallel randomized controlled trial

Background and objectives

The number of women of childbearing age with chronic diseases is rising. Evidence has shown that obstetric complications and poor psychological well-being are more prevalent among this group, in addition to these women reporting experiences of less than satisfactory care. More research is needed to investigate how to best meet the special needs of this group during pregnancy and postpartum. Previous research has shown that care coordination, continuity of care, woman-centered care, and specialized maternity care interventions delivered to women with high-risk pregnancies can improve patient-reported outcomes and pregnancy outcomes and be cost-effective. However, no previous trials have examined the efficacy and cost-effectiveness of such interventions among pregnant women with chronic diseases. This paper describes the protocol of a randomized controlled trial (RCT) of a midwife-coordinated, individualized and specialized maternity care intervention (ChroPreg) as an add-on to standard care for pregnant women with chronic diseases.

Methods/design

This two-arm parallel group RCT will be conducted from October 2018 through June 2020 at the Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Denmark. Pregnant women with chronic diseases are invited to participate; women will be randomized and allocated 1:1 to the ChroPreg intervention plus standard care or standard care alone. The ChroPreg intervention consists of three main components: (1) coordinated and individualized care, (2) additional ante- and postpartum consultations, and (3) specialized midwives. The primary outcome is length of hospital stay during pregnancy and in the postpartum period, and secondary outcomes are psychological well-being (five-item World Health Organization Well-Being Index, Edinburgh Postnatal Depression Scale, Cambridge Worry Scale), health-related quality of life (12-Item Short Form Health Survey), patient satisfaction (Pregnancy and Childbirth Questionnaire), number of antenatal contacts, and pregnancy and delivery outcomes. Data are collected via patient-administered questionnaires and medical records.

Discussion

This trial is anticipated to contribute to the field of knowledge on which planning of improved antenatal, intra-, and postpartum care for women with chronic disease is founded.

Trial registration

ClinicalTrials.gov, NCT03511508. Registered April 27, 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3405-5) contains supplementary material, which is available to authorized users.

AntiEpileptic drug Monitoring in PREgnancy (EMPiRE): a double-blind randomised trial on effectiveness and acceptability of monitoring strategies

BACKGROUND

Pregnant women with epilepsy on antiepileptic drugs (AEDs) may experience a reduction in serum AED levels. This has the potential to worsen seizure control.

OBJECTIVE

To determine if, in pregnant women with epilepsy on AEDs, additional therapeutic drug monitoring reduces seizure deterioration compared with clinical features monitoring after a reduction in serum AED levels.

DESIGN

A double-blind, randomised trial nested within a cohort study was conducted and a qualitative study of acceptability of the two strategies was undertaken. Stratified block randomisation with a 1 : 1 allocation method was carried out.

SETTING

Fifty obstetric and epilepsy clinics in secondary and tertiary care units in the UK.

PARTICIPANTS

Pregnant women with epilepsy on one or more of the following AEDs: lamotrigine, carbamazepine, phenytoin or levetiracetam. Women with a ≥ 25% decrease in serum AED level from baseline were randomised to therapeutic drug monitoring or clinical features monitoring strategies.

INTERVENTIONS

In the therapeutic drug monitoring group, clinicians had access to clinical findings and monthly serum AED levels to guide AED dosage adjustment for seizure control. In the clinical features monitoring group, AED dosage adjustment was based only on clinical features.

MAIN OUTCOME MEASURES

Primary outcome - seizure deterioration, defined as time to first seizure and to all seizures after randomisation per woman until 6 weeks post partum. Secondary outcomes - pregnancy complications in mother and offspring, maternal quality of life, seizure rates in cohorts with stable serum AED level, AED dose exposure and adverse events related to AEDs.

ANALYSIS

Analysis of time to first and to all seizures after randomisation was performed using a Cox proportional hazards model, and multivariate failure time analysis by the Andersen-Gill model. The effects were reported as hazard ratios (HRs) with 95% confidence intervals (CIs). Secondary outcomes were reported as mean differences (MDs) or odds ratios.

RESULTS

A total of 130 women were randomised to the therapeutic drug monitoring group and 133 to the clinical features monitoring group; 294 women did not have a reduction in serum AED level. A total of 127 women in the therapeutic drug monitoring group and 130 women in the clinical features monitoring group (98% of complete data) were included in the primary analysis. There were no significant differences in the time to first seizure (HR 0.82, 95% CI 0.55 to 1.2) or timing of all seizures after randomisation (HR 1.3, 95% CI 0.7 to 2.5) between both trial groups. In comparison with the group with stable serum AED levels, there were no significant increases in seizures in the clinical features monitoring (odds ratio 0.93, 95% CI 0.56 to 1.5) or therapeutic drug monitoring group (odds ratio 0.93, 95% CI 0.56 to 1.5) associated with a reduction in serum AED levels. Maternal and neonatal outcomes were similar in both groups, except for higher cord blood levels of lamotrigine (MD 0.55 mg/l, 95% CI 0.11 to 1 mg/l) or levetiracetam (MD 7.8 mg/l, 95% CI 0.86 to 14.8 mg/l) in the therapeutic drug monitoring group than in the clinical features monitoring group. There were no differences between the groups on daily AED exposure or quality of life. An increase in exposure to lamotrigine, levetiracetam and carbamazepine significantly increased the cord blood levels of the AEDs, but not maternal or fetal complications. Women with epilepsy perceived the need for weighing up their increased vulnerability to seizures during pregnancy against the side effects of AEDs.

LIMITATIONS

Fewer women than the original target were recruited.

CONCLUSION

There is no evidence to suggest that regular monitoring of serum AED levels in pregnancy improves seizure control or affects maternal or fetal outcomes.

FUTURE WORK RECOMMENDATIONS

Further evaluation of the risks of seizure deterioration for various threshold levels of reduction in AEDs and the long-term neurodevelopment of infants born to mothers in both randomised groups is needed. An individualised prediction model will help to identify those women who need close monitoring in pregnancy.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN01253916.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 23. See the NIHR Journals Library website for further project information.

The preconception care experiences of women with epilepsy on sodium valproate

PURPOSE

To understand the preconception experiences of women with epilepsy who have been taking the teratogenic drug valproate.

METHODS

Seven women were recruited, three from a preconception clinic and four from an antenatal clinic in a region of the UK. All had taken valproate preconceptionally. Three preconception clinic encounters were observed and audio-recorded. Interviews with all women were analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS

Women experienced a "trajectory of balance". Women moved from "maintaining balance" by using valproate to control seizures, to a "shattering of harmony" at the prospect of changing medication and as a result of the physical and mental effects of changing medication, to "restoring balance" which could involve "a new self" due to dramatic changes. Women balanced their health needs with those of their baby, and took responsibility for medication decision-making. They found it difficult to see "who is looking after me" in the healthcare system, either to access preconception care, or to support them through the stress of changing medication. Their journey ended with coming to terms with a variety of experiences: choosing not to have a baby due to unsuccessful change from valproate, recognising that a child from a previous pregnancy had been harmed by valproate or that the current pregnancy might be at risk, or successful medication change in preparation for pregnancy.

CONCLUSION

A clear and adequately funded preconception care pathway is needed from epilepsy diagnosis, including support for stress. Understanding what influences maternalisation may help understand uptake of preconception care.

Exploring the perception of women with epilepsy about pregnancy concerns: a qualitative study

Background and aim

Epilepsy is a common neurological disorder in pregnancy, which is associated with increased maternal and fetal adverse outcomes. This study aimed to explore the reproductive healthcare needs of women with epilepsy before, during and after childbirth.

Methods

This was a qualitative study using a content analysis method. The study population was marital women with epilepsy in reproductive age (15–45 years) referred to Imam Hossein Hospital, Tehran, Iran. Participants were 16 women chosen using purposive sampling with the consideration of maximum variation in sampling. Semi-structured interviews were held with the participants until data saturation was reached. The data were analyzed using the content analysis method. The MAXQDA software, version 2010, was used for the management of data.

Results

The data analysis led to the development of two categories. The first one is named ‘resilience against threats to safe pregnancy’ and has the following subcategories: (1) real physical complications and perceived (mental) conditions due to unwanted pregnancies, (2) the predisposing factors of anxiety related to safe pregnancy, (3) perceived consequences of pregnancy’, and (4) the approach to encounter perceived consequences of pregnancy. The second category is called ‘adverse experiences under inefficient supportive systems’ and has the following subcategories: (1) the insufficiency of reproductive healthcare services for women with epilepsy, (2) doubt about the advantages and disadvantages of breastfeeding, (3) stigma as a block to the treatment of the postpartum depression, and (4) playing the motherhood role under the shadow of self-esteem to lack of self-esteem.

Conclusion

In the prenatal, natal and postnatal duration, because of supportive system disruption and not receiving proper consultation, participants were often worried about not being able to get favorable conditions for safe pregnancy and controlling process of their pregnancy. Therefore, they often experienced unwanted pregnancy. They were also concerned about the adverse fetal outcomes. In postpartum period, they often experienced postpartum depression and were very doubtful about breastfeeding.

The experiences of people living with epilepsy in developing countries: a systematic review of qualitative evidence

BACKGROUND

Epilepsy is a global public health problem affecting people of all ages, sex, races, nations and social class. The majority of the 50 million people with epilepsy live in developing countries, with a prevalence rate of five to 10 people per 1000. The disease poses an enormous psychological, social and economic burden on patients. An estimated 90% of people with epilepsy in developing countries do not receive treatment due to sociocultural, economic and political factors. Current treatment interventions are limited to the clinical management of the disease and are largely driven by the healthcare provider's perspective, ignoring the experiences of people living with epilepsy (PLWE).

OBJECTIVE

The aim of this review was to identify, critically appraise, extract, synthesize and present the best and most current available evidence on the experiences of PLWE in developing countries.

REVIEW QUESTIONS

• What are the experiences of PLWE regarding the causes of their condition?• What are the experiences of PLWE regarding treatment of epilepsy?• How has epilepsy shaped the social relationships of the affected persons?

INCLUSION CRITERIA

People living with epilepsy in developing countries (Africa, Asia, Eastern Europe and Latin America).The experiences of PLWE in developing countries with particular attention on the causes, treatment and its impact on their social relationships.Primary research studies with a qualitative design not limited to phenomenology, ethnography, grounded theory, ethnomethodology, phenomenography, critical theory, interpretative or feminist analysis, case study, narrative studies and action research.

CONTEXT

Qualitative studies conducted in hospitals and community settings in developing countries.

SEARCH STRATEGY

A three-step search strategy was used to identify published and unpublished studies in the English language from the 1990s to the present.

METHODOLOGICAL QUALITY

Identified studies that met the inclusion criteria were retrieved and critically appraised by two independent reviewers prior to their inclusion using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).

DATA EXTRACTION

Data were extracted from included papers using the recommended data extraction form embedded in the JBI-QARI.

DATA SYNTHESIS

Findings, where possible, were pooled using the JBI-QARI. It involved the meta-aggregation of findings to generate a set of statements that represented that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning.

RESULTS

From the 13 studies included in the review, 113 findings were extracted to create categories. Eight categories were created from which three synthesized findings were produced. The synthesized findings were: SYNTHESIZED FINDING 1: People living with epilepsy believed that the disease was caused by factors such as fever, demonic power, beatings, witchcraft, curses and God. Patients also had differing views as to whether the disease was contagious or hereditary. They indicated that the disease manifested as seizures, triggered by fever, stress, depression and anger. SYNTHESIZED FINDING 2: People living with epilepsy used biomedical and traditional methods to treat epilepsy and also developed strategies for coping with the disease beyond seeking treatment. SYNTHESIZED FINDING 3: People living with epilepsy had negative and positive experiences in their social relationships. The negative experiences were linked to the social, psychological and economic burden of the disease on patients, whereas the social support they got from friends, peers, family and community members were the positive aspects.

CONCLUSION

People living with epilepsy attribute the cause of the disease to agents like fever, demonic power and witchcraft. Patients use biomedical and traditional methods to treat the disease and have also developed various coping strategies (like prayers and concealment) alongside treatment. Epilepsy has negative effects on the social relationships of patients and is a social, psychological and economic burden for patients. However, there are some positive effects like the social support they receive from family members, friends and the community.

Which information on women's issues in epilepsy does a community pharmacist need to know? A Delphi consensus study

OBJECTIVE

The aim of this study was to develop and achieve consensus on a core list of important knowledge items that community pharmacists should know on women's issues in epilepsy.

METHODS

This was a consensual study using a modified Delphi technique. Knowledge items were collected from the literature and from nine key contacts who were interviewed on their views on what information community pharmacists should have on women's issues in epilepsy. More knowledge items were suggested by five researchers with interest in women's issues who were contacted to rate and comment on the knowledge items collected. Two iterative Delphi rounds were conducted among a panel of pharmacists (n=30) to achieve consensus on the knowledge items to be included in the core list. Ten panelists ranked the knowledge items by their importance using the Analytical Hierarchy Process (AHP).

RESULTS

Consensus was achieved to include 68 knowledge under 13 categories in the final core list. Items ranked by their importance were related to the following: teratogenicity (10.3%), effect of pregnancy on epilepsy (7.4%), preconception counseling (10.3%), bone health (5.9%), catamenial epilepsy (7.4%), menopause and hormonal replacement therapy (2.9%), contraception (14.7%), menstrual disorders and infertility (8.8%), eclampsia (2.9%), breastfeeding (4.4%), folic acid and vitamin K (5.9%), counseling on general issues (14.7%), and sexuality (4.4%).

CONCLUSION

Using consensual knowledge lists might promote congruence in educating and/or training community pharmacists on women's issues in epilepsy. Future studies are needed to investigate if such lists can improve health services provided to women with epilepsy (WWE).

The neurotoxic effects of prenatal gabapentin and oxcarbazepine exposure on newborn rats

AIM

Teratogenicity is a problematic issue for pregnant women because of X-ray radiation, drugs, and genetic and unknown variables. First-generation antiepileptic drugs (AED) like valproic acid are well-known teratogens for developing fetuses. However, their usage is necessary in order to prevent maternal seizures. The underlying mechanism of birth defects associated with AED exposure remains unclear and information about the neurotoxic effects of prenatal exposure to AED is still limited. Oxcarbazepine (OXC) and gabapentin (GBP) are second-generation AED. It still remains unclear how much these drugs are safe during pregnancy. This study aimed to investigate whether any neurotoxic effect of OXC and GBP in utero exposure on the developing brain.

METHODS

Eighteen pregnant Wistar albino rats were divided into six groups. The first group was exposed to OXC at 100 mg/kg/day, the second to GBP at 50 mg/kg/day, and third to saline (0.9% NaCl) at 1.5 ml/day between the first and the fifth days of gestation. The same procedure was applied at the same dosages between the 6th and the 15th days of gestation for the 2nd three groups. Five female offspring (total n = 30, 45 days old) were taken from each group and stereological methods were applied in order to analyze the total and dopaminergic neuron number of the substantia nigra pars compacta (SNc).

CONCLUSION

The result is that the OXC and GBP exposure at different gestational periods may not give rise to congenital malformation and it appears that the GBP exposure during the organogenesis period proliferatively affects the total number of neurons.

Pregnancy-related knowledge, risk perception, and reproductive decision making of women with epilepsy in Korea

PURPOSE

To determine the influence of pregnancy-related knowledge and the risk perception on reproductive decision making in women with epilepsy.

METHODS

We enrolled women with epilepsy, who were of reproductive age and were considering having children in the future. A questionnaire was used to assess the level of pregnancy-related knowledge, perception of the offspring's risk for developing epilepsy or for having a congenial anomaly, and discussion with a physician concerning pregnancy-related issues. We evaluated the following outcome variables: (1) the decision to discontinue anti-epileptic drug (AED) during a future pregnancy regardless of the medical indication; and (2) the decision to have fewer children because of epilepsy.

RESULTS

We enrolled a total of 186 women with epilepsy. (1) Fifty-eight percent of the women were considering discontinuing AED during a future pregnancy regardless of the medical indication, and 25% of the women decided to have fewer children because of epilepsy. (2) The decision to discontinue AED during a future pregnancy was associated with low-level pregnancy-related knowledge. (3) The decision to have fewer children because of epilepsy was associated with an exaggerated perception of the offspring's risk for developing epilepsy. (4) The women who had ever discussed pregnancy-related issues with their physician were less likely to decide to discontinue AED during a future pregnancy; however, a discussion on this issue had no impact on their decision to have fewer children because of epilepsy.

CONCLUSION

More than 50% of the women would decide to discontinue AED during a future pregnancy, and 25% of the women stated that they would have fewer children because of epilepsy. These data highlight the importance of education on pregnancy-related issues and genetic risk counseling.