Real-world practices for the care of women with epilepsy during pregnancy: A Canadian perspective

Tadeu A Fantaneanu; Hayley F Thornton; Tinghua Zhang; Eduard Bercovici; Chantelle Hrazdil; Kristin M Ikeda; Janani Kassiri; Ana Suller Marti; Raluca Pana; Arezoo Rezazadeh; Eliane Kobayashi; Esther Bui; Canadian League Against Epilepsy, Women with Epilepsy workgroup

doi:10.1016/j.yebeh.2023.109468

Real-world practices for the care of women with epilepsy during pregnancy: A Canadian perspective

Epilepsy Behav. 2023 Nov:148:109468. doi: 10.1016/j.yebeh.2023.109468. Epub 2023 Oct 17.

Affiliations

¹ Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada. Electronic address: tfantaneanu@toh.ca.
² Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: hayley.thornton@albertahealthservices.ca.
³ Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada. Electronic address: tizhang@ohri.ca.
⁴ Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: eduard.bercovici@mail.utoronto.ca.
⁵ Division of Neurology, University of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia, Canada. Electronic address: Chantelle.Hrazdil@vch.ca.
⁶ Division of Neurology, Department of Medicine, Dalhousie University, Nova Scotia Health, Canada. Electronic address: kristin.ikeda@nshealth.ca.
⁷ Division of Pediatric Neurology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. Electronic address: Janani.Kassiri@albertahealthservices.ca.
⁸ Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Electronic address: Ana.SullerMarti@lhsc.on.ca.
⁹ Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada. Electronic address: raluca.pana@mcgill.ca.
¹⁰ Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada. Electronic address: arezazadeh@toh.ca.
¹¹ Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada. Electronic address: eliane.kobayashi@mcgill.ca.
¹² Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: esther.bui@uhn.ca.

PMID: 37857032
DOI: 10.1016/j.yebeh.2023.109468

Abstract

Objective: Approximately 150,000 Canadian women live with epilepsy, a population that presents with unique challenges. Our objective was to capture demographic and real-world practice characteristics of Canadian healthcare professionals providing care for women with epilepsy (WWE) with specific focus on reproductive considerations to identify potential gaps in knowledge and care.

Methods: A questionnaire developed by the Canadian League Against Epilepsy WWE workgroup was distributed to Canadian healthcare professionals from February 2021 to October 2022 to capture participant demographic characteristics and practice patterns in key areas of the reproductive cycle in WWE.

Results: A total of 156 participants completed the questionnaire, most being physicians (81.4%), epilepsy specialists (69.0%), and those who cared for adult patients (86.5%), with a significant proportion based at an academic center (65.4%). The majority of participants counselled on folic acid supplementation (89.7%). Participants selected lamotrigine and levetiracetam most frequently for either focal or generalized epilepsies during pregnancy. Additionally, 85.9% performed therapeutic drug monitoring during pregnancy. Almost all practitioners always or often counseled WWE on valproic acid on the benefits of switching to a less teratogenic medication (96.2%). Some geographic variability in practice patterns was noted with valproic acid being one of the top three medications selected for patients with generalized epilepsies in Western regions, although participants in Eastern regions had brivaracetam more commonly included as one of their top three agents for this population.

Significance: This is the first report of real-world Canadian practices in epilepsy care for women in pregnancy. Overall, our study reports that Canadian practice patterns conform well to current evidence and best-practice guidelines. Important variations in antiseizure medication selection across different regions were identified.

Keywords: Canadian; Epilepsy; Practices; Preconception; Pregnancy; Women.

MeSH terms

Adult
Anticonvulsants / therapeutic use
Canada / epidemiology
Epilepsy* / drug therapy
Epilepsy* / epidemiology
Epilepsy, Generalized* / drug therapy
Female
Humans
Pregnancy
Pregnancy Complications* / drug therapy
Valproic Acid / therapeutic use

Substances

Valproic Acid
Anticonvulsants