Vilstrup MacMillan (breakjury61)

We investigated the efficacy of lacosamide (LCM) polytherapy in improving seizure outcomes and psychiatric symptoms in patients with epilepsy with psychiatric comorbidities. We retrospectively collected data from medical records of outpatients of the Department of Psychiatry of Nishiniigata Chuo Hospital Epilepsy Center in Japan. We extracted data from all patients with epilepsy and psychiatric comorbidities who had been treated with LCM. We evaluated seizure prognosis and changes in psychiatric symptoms after LCM polytherapy. After LCM administration, 19 (47.5%) patients had improvements in seizure outcomes. The other 18 (45%) patients experienced no changes in seizure outcomes, and the remaining 3 (7.5%) patients experienced worse seizure outcomes after LCM polytherapy. LCM administration improved psychiatric symptoms in 21 (52.5%) of the 40 patients; psychiatric symptoms did not change in 14 (35%) patients and worsened in 5 patients (12.5%). There was no significant association between psychiatric and seizure prognoses. LCM polytherapy may have less negative influence on psychiatric comorbidities in patients with epilepsy compared with other antiseizure medications, and may also improve seizure severity. While LCM polytherapy might improve psychiatric symptoms as seizures improve, a small number of patients experienced worsening of psychiatric symptoms despite seizure improvement.To assess whether a formal collaboration between a non-surgical, community epilepsy center and a surgical, tertiary-care epilepsy center can improve patient progress throughout the pre-surgical referral process, and to elucidate predictors of referral completion among inter-center referrals. The inter-center referral process was tracked, and the number of patients completing surgical conference (primary outcome) and epilepsy surgery at the tertiary center were collected and compared in the 45-month immediate pre/post-collaboration periods. Demographic and clinical variables were collected on post-collaboration inter-center patient referrals to explore factors associated with completion of the referral process. Compared to the pre-collaboration period, the proportion of tertiary center epilepsy surgery conference patients referred from the community epilepsy center increased from 3/88 to 14/113 (263% increase, p = .01) during the post-collaboration period. The proportion of patients completing surgery via the community to tertiary referral process increased from 2/63 pre-collaboration to 8/71 post-collaboration (254% increase, p = .04). Referral completion was associated with higher seizure frequency, shorter travel distance, private insurance status and positive employment status (p less then 0.05). Collaboration agreements between community and tertiary-care epilepsy centers may improve patient completion of the epilepsy surgery referral process. Implementation of similar programs at other centers may be beneficial in reducing the epilepsy surgery gap. Limited or uncertain availability of nutritionally adequate and safe food, known as food insecurity, has been associated with obesity and other adverse health outcomes, but has rarely been studied in pregnancy. Food insecurity may negatively affect behavioral and physiological changes during pregnancy and may be associated with poor perinatal outcomes including gestational weight gain. Given the lack of information on the role of food insecurity in pregnancy and the possible relationship with perinatal outcomes such as gestational weight gain, the objective of this study was to examine the association between food insecurity and gestational weight gain in a diverse cohort of pregnant women. This was an observational study of 299 English-speaking women who delivered live-born singleton gestations at ≥24 weeks at a single tertiary care center. During their postpartum hospitalizations, enrolled women completed a survey of food security status during pregnancy using the U