Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada.
Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Epilepsy Behav. 2023 Nov;148:109468. doi: 10.1016/j.yebeh.2023.109468. Epub 2023 Oct 17.
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.
大约有 15 万名加拿大女性患有癫痫，这一人群面临着独特的挑战。我们的目的是了解为女性癫痫患者（WWE）提供护理的加拿大医疗保健专业人员的人口统计学和实际实践特征，特别关注生殖方面的考虑因素，以确定知识和护理方面的潜在差距。
由加拿大癫痫联盟 WWE 工作组制定的问卷于 2021 年 2 月至 2022 年 10 月分发给加拿大医疗保健专业人员，以了解 WWE 生殖周期关键领域的参与者人口统计学特征和实践模式。
共有 156 名参与者完成了问卷，其中大多数是医生（81.4%）、癫痫专家（69.0%）和照顾成年患者的人（86.5%），其中相当一部分人在学术中心工作（65.4%）。大多数参与者就叶酸补充剂进行了咨询（89.7%）。参与者在怀孕期间为局灶性或全面性癫痫最常选择拉莫三嗪和左乙拉西坦。此外，85.9%的人在怀孕期间进行了治疗药物监测。几乎所有的从业者总是或经常建议 WWE 患者权衡丙戊酸的利弊，以便换用致畸性较小的药物（96.2%）。实践模式存在一些地域差异，在西部地区，丙戊酸是治疗全面性癫痫患者的首选药物之一，尽管东部地区的参与者更常将布瓦西坦纳入此类人群的首选药物之一。
这是第一份关于加拿大妊娠期间女性癫痫护理实际实践的报告。总的来说，我们的研究报告表明，加拿大的实践模式与当前的证据和最佳实践指南相符。不同地区之间抗癫痫药物选择的重要差异已被确定。
