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Hughes A, Weckesser A, Denny E, Junaid F, Nelson-Piercy C, Black M, Allotey J, Thangaratinam S, Dyson J. Barriers and facilitators to healthcare practitioners providing care for pregnant women with epilepsy: A systematic review and narrative synthesis. Seizure 2024; 118:38-46. [PMID: 38631244 DOI: 10.1016/j.seizure.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Anita Hughes
- Centre for Social, Health and Related Research, Birmingham City University, Ravensbury Building, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom
| | - Annalise Weckesser
- Centre for Social, Health and Related Research, Birmingham City University, Ravensbury Building, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom
| | - Elaine Denny
- Centre for Social, Health and Related Research, Birmingham City University, Ravensbury Building, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom
| | - Fatima Junaid
- Institute of Metabolism and Systems Research, University of Birmingham, United Kingdom
| | | | - Mairead Black
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - John Allotey
- Institute of Metabolism and Systems Research, University of Birmingham, United Kingdom
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, United Kingdom; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Judith Dyson
- Centre for Social, Health and Related Research, Birmingham City University, Ravensbury Building, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom.
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Wilmshurst JM, Sperling MR. Equity in access to antiseizure medications: Who has the right to decide and what are the consequences of crisis decisions? Epilepsia 2023; 64:2011-2013. [PMID: 37326490 DOI: 10.1111/epi.17685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Michael R Sperling
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Oliveri NMB, Hansen JM, Almarsdóttir AB, Jacobsen R. The Awareness and Adherence of the Valproate Pregnancy Prevention Program: A Questionnaire Survey among Healthcare Professionals, Pharmacists, and Patients in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2215. [PMID: 36767582 PMCID: PMC9915910 DOI: 10.3390/ijerph20032215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The European Medicine Agency (EMA) provided additional recommendations regarding the use of valproate during pregnancy in 2018 by introducing a pregnancy prevention program (PPP). This study aimed to investigate the adherence and the impact of the PPP and the awareness of valproate teratogenicity among Danish healthcare professionals (HCPs) and patients. METHODS As part of the EMA initiated multi-country survey, web-based questionnaires were distributed among Danish general practitioners (GPs), medical specialists, pharmacists, and patients. RESULTS A total of 90 prescribers, 98 pharmacists, and 103 patients were included in the study. Some 95.0% of the prescribers, 78.6% of the pharmacists, and 81.6% of the patients were aware of the teratogenic risks of valproate. The patient guide (27.8%), the HCP guide (23.3%), direct healthcare professional communication (23.3%), and the warning sign on the outer medication package (23.5%) were the most applied measures from the PPP. A total of 54.4% of the prescribers and 32.7% of the pharmacists informed patients about the importance of effective contraception during the use of valproate. CONCLUSION The study showed that in Denmark HCPs and patients are highly aware of the teratogenic effects of valproate. However, adherence to and the impact of the measures included in the PPP were low.
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Affiliation(s)
- Nadia Maria Barbara Oliveri
- Department of Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | | | | | - Ramune Jacobsen
- Department of Pharmacy, University of Copenhagen, 2100 Copenhagen, Denmark
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La Neve A, Falcicchio G, Trojano M, Boero G. Seizure medication and planned pregnancy: balancing the risks and outcomes. Expert Rev Neurother 2022; 22:527-539. [PMID: 35726788 DOI: 10.1080/14737175.2022.2093107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The therapeutic management of women with epilepsy (WWE) of childbearing age can be complicated by the need to balance maternal/fetal risks related to seizure occurrence during gestation with the potential teratogenic risks related to the use of anti-seizure medications (ASMs). AREAS COVERED The authors review clinical evidence on seizure-related and ASM-related risks during pregnancy. Current regulatory indications are discussed, evaluating their impact on clinical practice, and ethical implications of pharmacological decisions are debated. EXPERT OPINION If properly informed about the maternal/fetal risks carried by different pharmacological choices, WWE can become the final decision makers regarding their care in every phase of their life. Over the coming years, analysis of aggregated pregnancy registry data on the structural impact, on the fetus, of low doses of valproate and of newer ASMs, together with analysis of the main population study data on functional (cognitive and behavioral) outcomes, could lead to huge advances, making choosing an ASM a less complex process for the clinician and a less painful decision for the woman. Future objectives should include identification of the potential role of the pharmacogenomic profile of WWE in determining the risk of fetal malformations.
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Affiliation(s)
- Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Giovanni Falcicchio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Giovanni Boero
- Complex Structure of Neurology, SS Annunziata Hospital, Taranto, Italy
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Kılıç B, Serdaroğlu E, Polat BG, İnce T, Esenülkü G, Topçu Y, Serdaroğlu A, Haspolat Ş, Tekgül H, Okuyaz Ç, Cansu A, Aydın K. Trends in the choice of antiseizure medications in juvenile myoclonic epilepsy: A retrospective multi-center study from Turkey between 2010 and 2020. Seizure 2022; 99:48-53. [DOI: 10.1016/j.seizure.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
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Clavenna A, Campi R, Putignano D, Fortino I, Bonati M. Changes in antiepileptic drug prescriptions over a decade in childbearing women in Lombardy region, Italy. Br J Clin Pharmacol 2022; 88:1152-1158. [PMID: 34427945 DOI: 10.1111/bcp.15053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 01/16/2023] Open
Abstract
AIMS To describe the antiepileptic drug (AED) prescription pattern in pregnant women and women of childbearing age in the 2010-2019 period in the Lombardy region, Italy. METHODS The Lombardy region administrative healthcare databases (2010-2019) were analysed. AEDs were classified as drugs belonging to the N03A subgroup of the Anatomical Therapeutic Chemical Classification System. Women aged 15-49 years were considered as being of childbearing age, while exposure during pregnancy was estimated taking into account the 12 months before delivery (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM codes in the diagnosis record from 650 to 659). RESULTS During 2019, 16 605 women of childbearing age (prevalence: 14.8‰) received at least 1 AED prescription. Pregabalin was the most widely used antiepileptic in women of childbearing age (22.3%), followed by valproic acid (20.0%). In 2010, the prevalence of valproic acid prescription to women of childbearing age was 30.2%; in 2019 this was 20.0%. In pregnant women, this prevalence was 24.9% in 2010 and 14.1% in 2019. Starting from 2017, levetiracetam and lamotrigine were the most commonly drugs prescribed to pregnant women. CONCLUSION Despite the decrease in valproic acid prescription over time, this drug is still among the most used AEDs, in particular in women of childbearing age. Educational interventions for healthcare professionals and women are needed in order to reduce the risk of unplanned pregnancy.
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Affiliation(s)
- Antonio Clavenna
- Laboratory of Pharmacoepidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Rita Campi
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Daria Putignano
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ida Fortino
- Lombardy Region Health Ministry, Lombardy Region, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Miranda-Silva C, Mendes-Coutinho F, Ferreira I, Ramos V, Carvalho MJ, Bombas T, Águas F, Moura P. Physician awareness regarding contraceptive counselling in women with chronic disease. EUR J CONTRACEP REPR 2021; 26:272-278. [PMID: 33719811 DOI: 10.1080/13625187.2021.1891409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Contraceptive counselling is essential in women with chronic disease, though it is frequently overlooked. We aimed to assess practices and awareness in contraceptive counselling in hospital physicians caring for reproductive age women with chronic disease. METHODS A questionnaire was distributed in April 2017 to physicians from 16 medical specialties in a tertiary care hospital in Portugal. Statistical analysis performed using Microsoft Office Excel® and IBM SPSS-Statistics®. RESULTS Two-hundred physicians participated in the survey: 59.5% were female, 55% under 35 years-old and 48.5% were residents. Only 26.5% practiced in surgical specialties. Two-thirds consistently inquired about the use of contraception. Most referred patients to Family Planning services or performed contraceptive counselling when pregnancy posed significant health risks (89.0%), when prescribing teratogenic medication (79.5%) or drugs with potential interaction with contraceptives (75.0%). Lack of training in contraception was the main reason for not referring patients to Family Planning services. While 83% considered counselling very important, only 5% had recently undergone training and 12.5% felt knowledgeable enough to perform it. Only 12.5% were aware of the institution's Family Planning resources. Female gender, non-surgical specialty, age over 35 years-old and over 10 years since specialisation were positively associated with awareness. CONCLUSION Most physicians addressed contraceptive management in women with comorbidities, but adequate training is lacking. Our results highlight the importance of communication between health care providers to achieve an adequate and multidisciplinary approach to reproductive and general health goals.
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Affiliation(s)
- Catarina Miranda-Silva
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal.,Department of Obstetrics-A, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Filipa Mendes-Coutinho
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal.,Department of Obstetrics-A, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iolanda Ferreira
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal.,Department of Obstetrics-A, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Vera Ramos
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria João Carvalho
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal.,Department of Obstetrics-A, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, Gynaecology University Clinic, University of Coimbra, Coimbra, Portugal
| | - Teresa Bombas
- Department of Obstetrics-A, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Fernanda Águas
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Paulo Moura
- Department of Obstetrics-A, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Mostacci B, Ranzato F, Giuliano L, La Neve A, Aguglia U, Bilo L, Durante V, Ermio C, Monti G, Zambrelli E, Lodi MAM, Galimberti CA. Alternatives to valproate in girls and women of childbearing potential with Idiopathic Generalized Epilepsies: state of the art and guidance for the clinician proposed by the Epilepsy and Gender Commission of the Italian League Against Epilepsy (LICE). Seizure 2020; 85:26-38. [PMID: 33418162 DOI: 10.1016/j.seizure.2020.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022] Open
Abstract
Following recent European Medication Agency restrictions on valproate (VPA) use in girls and women of childbearing potential (WOCP), the Commission on Epilepsy and Gender of the Italian League against Epilepsy integrated current literature and legislative data in order to provide clinicians with guidance on antiseizure medication (ASM) prescription for Idiopathic Generalized Epilepsies (IGEs) in this population, avoiding VPA. We reviewed the updated literature on ASMs and examined the teratogenicity of those showing efficacy in IGEs. For all relevant ASMs, we considered the indications for use and the pregnancy and contraception-related recommendations given in the Italian Summary of Product Characteristics (SmPC) and on the websites of the European Medicines Agency (EMA) and other European Union (EU) countries' regulatory agencies. With the exception of absence seizures, the literature lacks high quality studies on ASMs in IGEs. In girls and WOCP, levetiracetam and lamotrigine should be considered the first-choice drugs in Generalized Tonic-Clonic Seizures Alone and in Juvenile Myoclonic Epilepsy, lamotrigine in Juvenile Absence Epilepsy, and ethosuximide in Childhood Absence Epilepsy. Although supported by the literature, several ASMs are off label, contraindicated or burdened by special warnings in pregnancy. Some discrepancies emerged between the various SmPC warnings for different brands of the same active principle. We provided a therapeutic algorithm for each IGE syndrome and highlighted the need for revised prescription rules, consistent with the latest literature data, uniformity of SmPC warnings for the same active principle, and more data on the efficacy of new ASMs in IGEs and their safety in pregnancy.
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Affiliation(s)
- Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy(2)
| | | | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Leonilda Bilo
- Epilepsy Center, University of Napoli "Federico II", Napoli, Italy
| | - Vania Durante
- Ospedale "A. Perrino" di Brindisi- UO Neurologia, Brindisi, Italy
| | - Caterina Ermio
- Department of Neuroscience, "S. Giovanni Paolo II" Hospital, Lamezia Terme, Catanzaro, Italy
| | - Giulia Monti
- Neurology Unit, Ospedale Ramazzini di Carpi, AUSL di Modena, Italy
| | - Elena Zambrelli
- Epilepsy Center, ASST SS. Paolo e Carlo, San Paolo Hospital, Milano, Italy
| | - Monica Anna Maria Lodi
- Pediatric Neurology Unit and Epilepsy Center, Department of Neuroscience, Fatebenefratelli e Oftalmico, Hospital, Milano, Italy
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