Hormonal contraception in patients with epilepsy

Objectives: The aim of the study was to evaluate hormonal contraception use in women with epilepsy and to assess the risk of potential interactions between contraceptives and antiepileptic drugs (AEDs).  Material and methods: Data on hormonal contraception were obtained prospectively in women of childbearing age treated in the university epilepsy clinic.  Results: We evaluated 334 women with epilepsy (mean age 30.2 years). The majority of patients took one AED (193, 58%); the most commonly prescribed AEDs were: valproate, levetiracetam or lamotrigine. Hormonal contraception was used by 19 (5.7%) of all women of childbearing age. Only 7 patients (37%) of all those using hormonal contraception used prepa- rations that did not interact with AEDs; what is more 145 (46%) patients who did not use hormonal contraception were prescribed AEDs with high teratogenic potential (valproate or/and topiramate).  Conclusions: A very small percentage of women with epilepsy of childbearing potential used hormonal contraception. More than a half of that group simultaneously took AEDs that may interact with oral contraceptives. A large proportion of women taking AEDs with high teratogenic potential were not using hormonal contraception. As interaction between OC and AEDs are common, nonhormonal, highly effective methods, such as IUDs, may be ideal for women with epilepsy. The results of the study indicate the need for closer cooperation between neurologist and gynecologist caring for women with epilepsy

Safety of switching from brand-name to generic levetiracetam in patients with epilepsy

Purpose: The approach to the use of generic antiepileptic drugs has recently evolved from major concern to general acceptance, but the evidence related specifically to the safety of switching from brand-name to generic levetiracetam (LEV) is scarce. The aim of the study was to assess the risk of increased frequency of seizures or other adverse events after replacement of a brand-name LEV with a generic one. Patients and methods: This retrospective analysis included 159 patients treated with LEV in a tertiary outpatient epilepsy clinic. We included all patients diagnosed with epilepsy who were treated with LEV as at March 1, 2013. Most patients were forced to switch to the generic LEV because of the sudden rise in cost of the branded LEV. We recorded data on age, sex, age at onset of epilepsy, type of epilepsy, and its treatment. We analyzed data from one visit before potential switching and from two visits after the potential switching. The interval between visits was typically 3 months. We registered an increase in the frequency of seizures and in the occurrence of adverse events. Results: Among 151 subjects who switched to generic LEV after March 1, 2013, increased frequency of seizures was noted in 9 patients (6%) during the first follow-up visit. Patients with increased frequency of seizures did not differ from other patients regarding sex, age, age at the onset of epilepsy, and the median dose of LEV before switching or the median duration of treatment with LEV before switching. Two patients returned to brand-name LEV. Adverse events were noted in six other patients (4%) and included somnolence, irritability, or dizziness. Conclusion: Switching from brand-name to generic LEV is generally safe

Somatic comorbidity in Polish patients with epilepsy

A wide spectrum of somatic and psychiatric disorders occurs frequently in patients with epilepsy, which adds to the burden of this disease. The aim of the study was to estimate the prevalence and risk factors of somatic comorbidities and analyze somatic comedication in adult patients with epilepsy. This study involved patients with epilepsy treated in university epilepsy clinic. Data on epilepsy, antiepileptic drugs (AEDs), somatic comorbidities, and their treatment were collected from a structured interview and from medical records. The sample population consisted of 636 patients (mean age, 35.3 years); 380 (59.7%) were female and 241 (37.9%) had well‑controlled epilepsy. At least 1 comorbid somatic condition was found in 216 patients (34%). The most prevalent somatic comorbidities were cardiovascular diseases, allergies, migraine, hyperlipidemia, thyroid disorders, and chronic lower respiratory diseases. Furthermore, 200 patients (31.4%) were prescribed at least 1 medication for somatic disorders. Logistic regression analysis revealed several independent risk factors for the occurrence of somatic comorbidities: older age, shorter duration of epilepsy, lower seizure frequency, and lower number of AEDs. Somatic comorbidities and comedication with non‑AEDs were found in one‑third of the relatively young cohort of adult patients with epilepsy. Patients with pharmacoresistant epilepsy may be at risk of underdiagnosis and undertreatment of somatic comorbidities. The presence of comorbidities may have implications for the diagnosis and treatment of seizure disorder and coexisting condition

Subtypes of interictal depressive disorders according to ICD-10 in patients with epilepsy

Background and purpose: The purpose of the study was to evaluate the frequency of interictal depressive symptoms and different subtypes of depressive disorders according to 10th revision of the International Classification of Diseases (ICD-10) criteria in patients with epilepsy and its association with the type of epilepsy. Material and methods: 289 outpatients with epilepsy (169 females, 120 males) aged 18-82 years completed Beck Depression Inventory (BDI). Subjects who scored >11 in BDI were further evaluated by the psychiatrist according to the ICD-10 diagnostic criteria. Results: 41.9% (121) of the 289 participants scored >11 in BDI. 104 (85.9%) patients who scored >11 in BDI had comorbid mental disorders according to ICD-10 criteria. The most common were organic mood disorders (F06.3 – 31.4%), depressive episode (F32 – 22.3%) and dysthymia (F34.1 – 9.1%) There were no differences in the prevalence of depression and subtypes of depression in patients with certain epilepsy types. Depression was diagnosed before entering the study in only one third of patients with final diagnosis of depression. Conclusions: Our results confirm the prevailing view that interictal depression is common in epilepsy patients. Depression remains underrecognized and undertreated in patients with epileps

Subtypes of interictal depressive disorders according to ICD-10 in patients with epilepsy

Background and purpose The purpose of the study was to evaluate the frequency of interictal depressive symptoms and different subtypes of depressive disorders according to 10th revision of the International Classification of Diseases (ICD-10) criteria in patients with epilepsy and its association with the type of epilepsy. Material and methods 289 outpatients with epilepsy (169 females, 120 males) aged 18–82 years completed Beck Depression Inventory (BDI). Subjects who scored >11 in BDI were further evaluated by the psychiatrist according to the ICD-10 diagnostic criteria. Results 41.9% (121) of the 289 participants scored >11 in BDI. 104 (85.9%) patients who scored >11 in BDI had comorbid mental disorders according to ICD-10 criteria. The most common were organic mood disorders (F06.3 – 31.4%), depressive episode (F32 – 22.3%) and dysthymia (F34.1 – 9.1%) There were no differences in the prevalence of depression and subtypes of depression in patients with certain epilepsy types. Depression was diagnosed before entering the study in only one third of patients with final diagnosis of depression. Conclusions Our results confirm the prevailing view that interictal depression is common in epilepsy patients. Depression remains underrecognized and undertreated in patients with epilepsy

Suicidality and its determinants among Polish patients with epilepsy

Background and purpose The aim of this study was to evaluate the prevalence of suicidal ideation among Polish patients with epilepsy and to assess the potential determinants of suicidality in this cohort. Material and methods The study comprised 301 patients with epilepsy seen in the tertiary epilepsy clinic. Patients’ characteristics included demographic variables, epilepsy-related variables, as well as occurrence of comorbidities, ongoing use of any other medications, family history of epilepsy and/or depression. Beck Depression Inventory (BDI) was used to assess depressive symptoms, and question no. 9 of BDI was specifically used to reveal suicidality. Results Mean age of subjects was 35.5 years. 113 (37.5%) had frequent seizures and 96 patients (31.9%) had remission. BDI score>11 points (suggestive for depression) was found in 127 subjects. Suicidal ideation has been revealed in 30 (10.0%) out of 301 studied patients. Patients with suicidal ideation were older and more commonly reported frequent seizures. Almost all of them (93.3%) had clinically significant depressive symptoms (BDI score>11). Multivariate analysis revealed that severity of depressive symptoms (OR=1.16 per one-point increase in BDI score, 95% CI: 1.10–1.22, p<0.001) and the use of potentially depressogenic medication (OR=3.04, 95% CI: 1.04–8.89, p=0.04) were independent determinants of suicidality among studied patients. Conclusions Suicidal ideations were revealed by about 10% of studied epileptic patients who visited tertiary center for epilepsy. Independent predictors of suicidality among studied patients included depression itself and the use of potentially depressogenic medication