Support systems of women with epilepsy in pregnancy: A retrospective needs assessment

Psychosocial burden in mothers with epilepsy and their caregiver: Feasibility and preliminary results of a digital screening procedure

OBJECTIVE

The present study aims to evaluate the feasibility of utilizing a digital procedure to screen for anxiety and depression as well as impairments in psychosocial aspects, such as social support, social activity and quality of life (QoL) in women with epilepsy (WWE) after childbirth. Furthermore, the study intends to digitally screen for burden of the respective caregivers in WWE compared to a healthy control group.

MATERIALS AND METHODS

This comparative cross-sectional study was conducted in the post-partum period on 30 WWE and 33 healthy controls who gave birth between 01/2018 and 05/2021. Additionally, 24 caregivers of WWE and 26 caregivers of healthy mothers took part in this study. Information on psychosocial health and psychosocial burden was collected digitally using the short version of the Social Support Questionnaire, the Social Activity Self-Report Scale and the Hospital Anxiety and Depression Scale. The caregiver burden was digitally assessed with the Zarit Burden Scale in its German adaptation (i.e., Zarit Burden Interview and the Family Burden Questionnaire). Furthermore, QoL was assessed with the QOLIE-31 (Quality of Life in Epilepsy Inventory) in WWE and with the Life Satisfaction Questionnaire in healthy controls.

RESULTS

When comparing WWE and healthy controls, the groups were comparable on psychosocial aspects, such as self-reported social support, anxiety, depression and social activity, when assessed with self-report measures in a digital screening procedure. Although not significantly different between groups, anxiety, depression, self-reported social support and social activity were correlated with overall QoL in both, WWE and healthy controls. Caregivers of WWE and healthy controls were neither significantly different in their objective burden nor in their subjective burden as reported in digitally applied self-report measures.

CONCLUSION

Although not significantly different between groups, given the correlation between psychosocial aspects and QoL, it is worthwhile to include these aspects in standard clinical screening extending beyond the screening of anxiety and depression in WWE. Overall, the preliminary psychosocial data presented in this study suggest that a digital assessment of psychosocial burden seems reasonable in WWE and warrants integration into further research and clinical practice. Nevertheless, since no significant differences concerning psychosocial aspects were found in the present study, one may argue that highly specialized clinical care, as provided in the present study, may counteract potential psychosocial impairment experienced by WWE who do not receive such specialized care. Hence, further investigations outside of specialized outpatient clinics as well as prospective investigations of subjective factors that may dynamically change during pregnancy ought to be addressed in clinical practice and research for improving care during and after pregnancy in WWE.

Peer support and social network groups among people living with epilepsy: A scoping review

BACKGROUND

Peer support is a unique connection formed between people who share similar experiences of illness. It is distinct from, but complementary to other forms of support or care provided by family and friends, healthcare professionals, and other service providers. The role of peer support in contributing to the wellbeing and care of people living with epilepsy (PLWE) is increasingly recognized, including via online networks and group therapy. However, little overall synthesis is available to map and conceptualize the different ways peer support contributes to the wellbeing or care of PLWE, or how it occurs via formally and informally organized social network settings.

METHODS

A scoping review of peer-reviewed literature published between 1998 and 2021 was conducted using Medline, Psychinfo, Embase, Scopus, and CINAHL databases. Included studies comprised empirical research that involved people with epilepsy as the primary participants; included 'peer social support' in the study question or study setting, and included outcome measures related to peer social support or peer-related groupings.

RESULTS

A total of 17 articles were included in the review. The functions of peer support for PLWE can be described as either emotional or instrumental. Emotional peer support includes a sense of empathy and encouragement gained from another person with a shared experience of illness, which can help to improve confidence for those challenged by isolation and stigma. Instrumental peer support refers to the more practical and tangible support provided by peers about treatment and support services, which can improve self-management and clarify misinformation. The mechanisms by which peer support and peer social networks materialize includes face-to-face meetings, online group gatherings, and telephone calls. As well as through organized channels, peer support can be fostered incidentally through, for example, research participation, or in clinical settings. Barriers to PLWE receiving opportunities for peer support include the perceived stigma of living with epilepsy, the high cost of transportation, or poor access to the internet to reach and meet others; enablers include the anonymity afforded by online forums and perceived trust in one's peers or forum organizers.

CONCLUSIONS

This nuanced conceptualization of the different types of peer support and peer support networks, as well as the variety of barriers and enablers of peer support for PLWE, will serve to inform more effectively designed clinical care practices and service delivery tailored to the needs of PLWE. This review will inform future research in peer support as an important and emerging area of investigation.

Knowledge of pregnancy and procreation in women with epilepsy of childbearing age: A 16-year comparative study in Poland

Studies across countries and time periods have demonstrated insufficient pregnancy-related knowledge in women with epilepsy (WWE) of childbearing age. To assess the current state of such knowledge as well as the relevant time-related changes over 16 years in Poland, we conducted a study of WWE using a questionnaire developed in 2003. The participants were 656 WWE of childbearing age who completed online and paper-based questionnaires. The results were compared with those obtained in 2003. Overall, pregnancy-related knowledge improved significantly over 16 years. This improved knowledge was most evident in preconception use of folic acid and breastfeeding. However, even now, less than 40% of WWE believe that breastfeeding is possible in most cases. In 2019, pregnancy-related knowledge was positively correlated with participants' educational level and hometown size and negatively correlated with the frequency of generalized tonic-clonic seizures. Women completing the online survey had better knowledge than those who completed the paper-based survey. Indications for cesarean section, the possibility of using oral contraception and breastfeeding are the areas where knowledge in WWE remains inadequate, necessitating targeted educational activities.

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.

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.