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

•Most Canadian respondents recommended between 1 and 4 mg of folic acid for prepartum women with epilepsy (WWE).•Lamotrigine and levetiracetam were the most commonly prescribed medications for WWE with focal or generalized epilepsies.•Most respondents offered therapeutic drug monitoring (TDM) at som...

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Bibliographic Details
Published in:Epilepsy & behavior 2023-11, Vol.148, p.109468-109468, Article 109468
Main Authors: Fantaneanu, Tadeu A., Thornton, Hayley F., Zhang, Tinghua, Bercovici, Eduard, Hrazdil, Chantelle, Ikeda, Kristin M., Kassiri, Janani, Suller Marti, Ana, Pana, Raluca, Rezazadeh, Arezoo, Kobayashi, Eliane, Bui, Esther
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Language:English
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Summary:•Most Canadian respondents recommended between 1 and 4 mg of folic acid for prepartum women with epilepsy (WWE).•Lamotrigine and levetiracetam were the most commonly prescribed medications for WWE with focal or generalized epilepsies.•Most respondents offered therapeutic drug monitoring (TDM) at some point during pregnancy, but only 50% of participants offered monthly TDM regimens.•Canadian practice patterns conform well to current guidelines and practice parameters on the care of WWE. 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. 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. 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. 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.
ISSN:1525-5050
1525-5069
DOI:10.1016/j.yebeh.2023.109468