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Background: Animal data suggest teratogenic effects with zonisamide use and risk of pregnancy losses. Human data following zonisamide exposure are presently limited, but suggest low risk of malformation with elevated risk of low birth weight.Objective: To calculate the major congenital malformation (MCM) rate of zonisamide in human pregnancy and assess for a signal of any specific malformation pattern and associations with birth weight.Methods and Materials: Data were obtained from the UK and Ireland Epilepsy and Pregnancy register (UKIEPR) which is an observational, registration, and follow up study from December 1996 to July 2020. Eligibility criteria were use of zonisamide and to have been referred to the UKIEPR before the outcome of the pregnancy was known. Primary outcome was evidence of MCM.Results: From December 1996 through July 2020 there were 112 cases of first trimester exposure to zonisamide, including 26 monotherapy cases. There were 3 MCM for monotherapy cases (MCM rate 13.0% (95% confidence interval 4.5-32.1)), and 5 MCM for polytherapy cases (MCM rate 6.9% (95% confidence interval 3.0-15.2)). While the median birth weight was on 71st and 44th centile for monotherapy and polytherapy cases respectively, there was a high rate of infants born small for gestational age (21% for both).Conclusion: These data raise concerns about a signal for potential teratogenicity with zonisamide in human pregnancy. Given the low numbers reported, further data will be required to adequately counsel women who use zonisamide in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: In the general population folic acid supplementation during pregnancy has been demonstrated to reduce the frequency of major congenital malformations (MCMs) such as neural tube defects (NTDs). Women with epilepsy contemplating pregnancy are advised to take supplemental folic acid due to the known anti-folate effect of some anti-epileptic drugs (AEDs). Here we aim to determine effectiveness of this practice. Methods: Prospective, observational, registration and follow-up study. Cases are women with epilepsy who become pregnant and who are referred before outcome of the pregnancy is known. The main outcome measure is the MCM rate. Results: In 1,935 cases reported to have received pre-conceptual folic acid, 76 MCMs (3.9%;95% C.I. 3.1 - 4.9%) and eight NTDs (0.4%; 95% C.I. 0.2 - 0.8) were identified. For 2,375 women who were reported to have received folic acid but not until later in the pregnancy (n= 1,825) or not at all (n=550) there were 53 outcomes with an MCM (2.2%; 95% C.I. 1.7 - 2.9%) and eight NTDs (0.34%; 95% C.I. 0.2 - 0.7). Conclusions: Extrapolation from studies carried out in the general population to groups of women with epilepsy may be questionable. The increased risk of MCM recorded in this group may occur through mechanisms other than that of folic acid metabolism. [ABSTRACT FROM AUTHOR]

Background: Nonadherence to antiepileptic drugs (AEDs) can result in suboptimal outcomes for patients., Aim: This study aimed to assess the utility of a theory-based approach to understanding patient perspectives on AEDs and adherence., Method: Patients with epilepsy, identified by a GP case note review, were mailed validated questionnaires assessing their perceptions of AEDs and their adherence to them., Results: Most (84.9%) of the 398 AED-treated respondents accepted the necessity of AEDs, but over half expressed doubts, with 55% disagreeing or uncertain about the statement 'I would prefer to take epilepsy medication than risk a seizure'. Over a third (36.4%) expressed strong concerns about the potential negative effects of AEDs. We used self-report and medication possession ratio to classify 36.4% of patients as nonadherent. Nonadherence was related to beliefs about medicines and implicit attitudes toward AEDs (p<0.05). Adherence-related attitudes toward AEDs were correlated with general beliefs about pharmaceuticals (BMQ General: General Harm, General Overuse, and General Benefit scales) and perceptions of personal sensitivity to medicines (PSM scale)., Conclusion: We identified salient, adherence-related beliefs about AEDs. Patient-centered interventions to support medicine optimization for people with epilepsy should take account of these beliefs., (© 2013.)

Compared to the background population, people with epilepsy tend to have lower rates of education and employment, lower rates of marriage and childbearing, and lower overall socioeconomic status (SES). Disparities in epilepsy care based on sociodemographic factors have been observed in the literature, but it is not known whether any such disparities exist in the UK. The UK Epilepsy and Pregnancy Register is a prospective, observational, registration and follow-up study that was set up to determine the relative safety of all AEDs taken in pregnancy. Here, we report outcomes of registered pregnancies to women with epilepsy living in Scotland from December 1996 to June 2012, based on the degree of socioeconomic deprivation of their postcode area. The Scottish Index of Multiple Deprivation (SIMD) quintile scores from 2006 were used to determine degree of socioeconomic deprivation, and group 1 (most deprived) and group 5 (least deprived) were compared. There were 1526 pregnancies with complete outcome data to women living in Scotland. Of these, 1453 (95.1%) resulted in a live birth and 68 (4.7%) had a major congenital malformation (MCM). Postcodes could not be reliably identified or verified for an additional three women, who have been excluded from SIMD group analysis. Of all women included in this study, 32.4% were in group 1 and 13.2% in group 5. No difference in MCM rate was observed between the two groups (4.4% in group 1 compared to 4.7% in group 5, p=0.84). Women in group 5 were more likely to take preconceptual folic acid (56.8% compared to 14.0%, relative risk: 4.1; 95% CI: 3.1-5.2) and less likely to have generalized tonic-clonic seizures in pregnancy (13.0% compared to 29.2%, relative risk: 0.4; 95% CI: 0.3-0.7) than those in group 1. Women in group 5 were more likely to be on monotherapy regimens (80.2% compared to 65.9%, relative risk: 1.2; 95% CI: 1.1-1.3), less likely to be on valproate (19.5% compared to 28.0%, p=0.05), and more likely to be on lower doses of the drug (825.9mg/day compared to 1012.0mg/day, p=0.05) compared to those in group 1. Although no change in MCM rate was seen based on SES, differences in treatment between socioeconomic groups do exist, particularly for preconceptual folic acid consumption, AED regimen, and seizure frequency. Greater emphasis on the importance of preconceptual counseling, both to discuss AED choice and folic acid intake, would be of benefit, particularly to those living in areas of high socioeconomic deprivation, to improve equity of healthcare delivery for women with epilepsy in Scotland., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The success of integrating an algorithm of care for amyotrophic lateral sclerosis (ALS) into community practice depends on highlighting the benefits to patients and families and demonstrating those benefits to clinicians and service providers. The key issues in providing care for patients with ALS are the delay in establishing a diagnosis, variable access to necessary multidisciplinary services in health and social care, the need for further research to improve the prognosis, and increasing the level of information about ALS among professionals. Achieving an accurate diagnosis as soon as possible can enable focused services to be available earlier and can enable a management plan to be drawn up in anticipation of clinical deterioration. In view of the low incidence of the condition, it may be prudent to include ALS education as part of a broader neurologic educational initiative. Voluntary organizations, patients and their families, specialist liaison nurses, and pressure groups can all be powerful influences on the provision of health care and public/professional education. Adoption of the algorithm into community practice is likely to be a gradual process, involving a number of different approaches. The only general guidance is to carefully consider the key messages and their intended target audiences.

In the past decade there has been increasing interest in the part that general practice can play in the care of people with epilepsy. Primary care services for epilepsy vary from practice to practice. Some studies have suggested that people with epilepsy prefer secondary care services and are not keen for their epilepsy to be managed in general practice, but much of the data were collected in secondary care. This study collected data from various sources about present provision of services, patient satisfaction with services, views about service development, areas where GP knowledge may be improved and whether the site of data collection influenced the results. A questionnaire was piloted, then distributed and collected through branches of the British Epilepsy Association, general practice and secondary care clinics. Data collected were both quantitative and qualitative. One hundred and seventy-eight questionnaires were collected from three sources. The responders were a severe seizure group. Structured care in general practice was uncommon with 54% being seen only when needed. Dose and type of antiepileptic medication was rarely altered in general practice. Information about their condition was given to 44% of the responders by their GP. Sixty-one percent would prefer their epilepsy care to be 'shared' between primary and secondary services. The majority of patients were satisfied with GP services, felt they could easily discuss their epilepsy, but 58% felt they 'rarely' or 'never' received enough information about their condition in general practice. Satisfaction with GP care varied, dependent on where the data were collected. Patients would value more information and more time to discuss the effects of their epilepsy. In conclusion general practice care for epilepsy is still reactive. Patients value more information and more time to discuss implications. The data collection point affects the results; any conclusions about the organisation of epilepsy care should draw data from community patient samples.

All the girls at a boarding school who presented with symptoms of influenza were interviewed and examined. Their symptoms and signs were recorded and related to age, date of last menstrual period, and previous influenza immunization.The age of the girls had no influence on the incidence of disease, nor did the number of girls in each form. However, the attack rate among those not immunized was 61 per cent and those not immunized 71 per cent. There was a highly significant variation in the incidence of influenza in relation to the menstrual cycle.