Valproic acid and socioeconomic associations in Swedish women with epilepsy 2010–2015

Andersson, Klara; Ozanne, Anneli; Bolin, Kristian; Tomson, Torbjörn; Zelano, Johan

doi:10.1111/ane.13397

Cited by 5 publications

(6 citation statements)

References 13 publications

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“…The education level of responders to our survey were both encouraging and disappointing. Forty percent of users of the information module had a university education, which fits very well with the proportion seen in a recent register‐based study of all women with epilepsy without intellectual disability in Sweden 21 . However, 67% of users of the pregnancy module had a university education.…”

Section: Discussionsupporting

confidence: 84%

“…Forty percent of users of the information module had a university education, which fits very well with the proportion seen in a recent register‐based study of all women with epilepsy without intellectual disability in Sweden. 21 However, 67% of users of the pregnancy module had a university education. This could suggest that our system mainly enhances the epilepsy care of patients of a high socioeconomic position.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Survey of an online system for information to women with epilepsy of childbearing age and management during pregnancy: A 3‐year evaluation

Smith Malm,

Klecki,

Lisovska

et al. 2024

Epilepsia Open

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ObjectiveWe developed an online tool for women with epilepsy consisting of two modules: one with information on pregnancy‐related issues (information module) and one for reminders about blood test and communication about dose changes (pregnancy module) . Our aim was to assess perceived value, user‐friendliness, and improvement of patient knowledge in users.MethodsThe system was launched in 2019 and patients invited by epilepsy nurses were asked to participate in a survey one month after the invitation for the information module, and one month postnatally for the pregnancy module.ResultsBy November 2022, the system had been used by 96 individuals out of 100 invited in the pregnancy module, in a total of 114 pregnancies. 111 women had been invited to the information module, and 70 of these accessed it. The survey received 96 answers (44 information, 52 pregnancy). User‐friendliness was rated as good or very good by a little over half of the users; 55% in the information module and 52% in the pregnancy module. Among pregnant women, 83% found the TDM part useful and most would prefer a similar system in future pregnancies. Sixty‐four percent of users of the information module and 48% of the pregnancy module found that the system had increased their knowledge. Two knowledge questions were answered correctly by a significantly higher proportion of those that had accessed the online information.SignificanceThere was great demand for online communication during pregnancy and our experiences of implementation can hopefully assist digitalization of epilepsy care elsewhere. Online information also seems to increase knowledge about pregnancy‐related issues, but our invitation‐only method of inclusion was not effective for widespread dissemination. Patient‐initiated access with optional epilepsy‐team contact if questions arise could be an alternative.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Survey of an online system for information to women with epilepsy of childbearing age and management during pregnancy: A 3‐year evaluation

Smith Malm,

Klecki,

Lisovska

et al. 2024

Epilepsia Open

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“…16 We have studied the use of VPA in women of childbearing age in Sweden on a population-wide scale and found a decreasing use, reflecting increased awareness of negative effects, commencing before the EMA restrictions of 2018. 17 There are also other aspects of the pregnancy prevention programme that have not been assessed in Sweden or Norway. Studies in other countries have for instance found the EMA restrictions to increase use of contraceptive methods in women with VPA for psychiatric indications.…”

Section: Discussionmentioning

confidence: 99%

Valproate Restrictions in Sweden and Norway: Online survey suggests implementation deficit

Zelano

Sveberg

Taubøll

et al. 2022

Acta Neuro Scandinavica

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Objectives To assess knowledge among neurologists in Sweden and Norway on the restrictions issued by the European Medicines Agency (EMA) regarding use of valproic acid (VPA) to female patients of childbearing potential, their use of the pregnancy prevention programme and their VPA prescription habits. Materials & Methods We conducted an online survey from May through September 2021 inviting neurologists in Sweden and Norway to participate. The questions assessed familiarity with the EMA restrictions, knowledge and use of the information material issued by Market Authorization Holders (MAH) of VPA, and experience of VPA prescriptions to women of childbearing age in the last 2 years. Results The survey received 202 responses (response rate ≈ 20%). Of the responders, 51% were well acquainted with the EMA restrictions, and 49% were aware of the MAH‐issued educational material. Eighty‐eight (44%) had prescribed VPA to women of childbearing age in the last 2 years, and of these, only a small minority (n = 13) regularly used the information brochure for patients, and even fewer (n = 8) the VPA risk acknowledgement forms. Conclusions We found limited penetrance of the new EMA restrictions on VPA use as well as limited acceptance and use among prescribers of the current company‐issued information material and risk acknowledgment forms. More information campaigns and closer collaboration with treating physicians are likely needed.

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“…Even when on treatment, disparities in drug choice persist, including in what may be inappropriate care. A population-based study of women living in Sweden aged 18–45 years between 2010 and 2015, with a diagnosis of epilepsy and no intellectual disability ( n = 9143) found socioeconomic differences in the frequency of valproic acid (VPA) prescription [6]. Guidelines in Europe (and around the world) suggest that VPA should be avoided in women of child-bearing age.…”

Section: Epilepsy Diagnosis Ambulatory Care and Medication Initiationmentioning

confidence: 99%

Socioeconomic disparities in epilepsy care

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2022

Current Opinion in Neurology

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Purpose of reviewEpilepsy is a common, chronic neurologic disease with continued disparities in care. The COVID-19 pandemic and recent social movements have drawn greater attention to social determinants of health and our progress (or lack thereof) toward delivering more equitable care.Recent findingsRecent studies continue to document racial and economic disparities in diagnosis, treatment, and overall care of epilepsy and associated conditions. Notably, an increasing number of studies are attempting to design healthcare pathways and other interventions to improve access and equity in epilepsy care.SummaryThe present literature highlights the importance of identifying and addressing the particular needs of vulnerable persons with epilepsy. Practitioners and researchers should continue to develop interventions aimed at improving care for all patients and, crucially, measure the impact of their changes to ensure that any interventions are truly advancing health equity.

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Valproic acid and socioeconomic associations in Swedish women with epilepsy 2010–2015

Cited by 5 publications

References 13 publications

Survey of an online system for information to women with epilepsy of childbearing age and management during pregnancy: A 3‐year evaluation

Survey of an online system for information to women with epilepsy of childbearing age and management during pregnancy: A 3‐year evaluation

Valproate Restrictions in Sweden and Norway: Online survey suggests implementation deficit

Socioeconomic disparities in epilepsy care

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