Summary Recent clinical trials indicate that cannabidiol (CBD) may reduce seizure frequency in pediatric patients with certain forms of treatment-resistant epilepsy. Many of these patients experience significant impairments in quality of life (QOL) in physical, mental, and social dimensions of health. In this study, we measured the caregiver-reported Quality of Life of Childhood Epilepsy (QOLCE) in a subset of patients enrolled in a prospective, open-label clinical study of CBD. Results from caregivers of 48 patients indicated an 8.2 ± 9.9 point improvement in overall patient QOLCE (p<0.001) following 12 weeks of CBD. Subscores with improvement included energy/fatigue, memory, control/helplessness, other cognitive functions, social interactions, behavior and global QOL. These differences were not correlated to changes in seizure frequency or adverse events. The results suggest that CBD may have beneficial effects on patient QOL, distinct from its seizure-reducing effects, however further studies in placebo-controlled, double-blind trials are necessary to confirm this finding.

IMPORTANCE Children with benign epilepsy with centrotemporal spikes (BECTS) have traditionally been considered to have a uniformly good prognosis. However, benign may be a misnomer because BECTS is linked to cognitive deficits, a more severe phenotype with intractable seizures, and the potential for sudden unexpected death in epilepsy (SUDEP). OBJECTIVE To determine if cases of BECTS are present in the North American SUDEP Registry (NASR). DESIGN, SETTING, AND PARTICIPANTS The NASR is a clinical and biospecimen repository established in 2011 to promote SUDEP research. The NASR database, which includes medical records, results of electroencephalographic tests, and interviews with family members of patients with epilepsy who died suddenly without other identifiable causes of death, was queried from June 3, 2011, to June 3, 2016, for cases of BECTS. The patients with epilepsy had died suddenly without other identifiable causes of death (eg, drowning, trauma, exposure to toxic substances, or suicide); SUDEP classification was determined by the consensus of 2 epileptologists. MAIN OUTCOMES AND MEASURES Cases of SUDEP among children who received a diagnosis of BECTS among patients reported in the NASR. RESULTS Three boys (median age at death, 12 years; range, 9-13 years) who received a diagnosis of BECTS by their pediatric epileptologist or neurologists were identified among 189 cases reported in the NASR. The median age of epilepsy onset was 5 years (range, 3-11 years), and the median duration of epilepsy was 4 years (range, 1-10 years). Two deaths were definite SUDEP, and 1 was probable SUDEP. Independent review of clinical and electroencephalographic data supported the diagnosis of BECTS in all 3 patients. None of the patients was prescribed antiseizure drugs, either owing to physician recommendation or mutual decision by the physician and parents. All 3 patients were found dead in circumstances typical of SUDEP. The 3 patients spanned the spectrum of BECTS severity: 1 had only a few seizures, 1 had more than 30 focal motor seizures, and 1 had 4 witnessed generalized tonic-clonic seizures and approximately 30 suspected generalized tonic-clonic seizures. CONCLUSIONS AND RELEVANCE Sudden unexpected death in epilepsy is a very rare outcome in BECTS that clinicians should consider discussing in appropriate circumstances and possibly factoring into treatment decisions.

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weight change as BMI class increased. For the women who kept the EI for 3 years, the median weight change (interquartile range) per BMI class was: normal/underweight 3.2 kg (-0.5, 6.4), overweight 5.2 kg (-0.5, 9.3), class I obese 5.7 kg (0.2, 10.7), class II obese 9.1 kg (2.3, 13.6), and class III 5.0 kg (-2.3, 13.2).CONCLUSION: There was no trend in weight change after placement of the EI as BMI class increased. The greatest increase in weight occurred in the class II group at 3 years. This information will be useful in counseling obese women about the EI when discussing contraceptive options.

weight change as BMI class increased. For the women who kept the EI for 3 years, the median weight change (interquartile range) per BMI class was: normal/underweight 3.2 kg (-0.5, 6.4), overweight 5.2 kg (-0.5, 9.3), class I obese 5.7 kg (0.2, 10.7), class II obese 9.1 kg (2.3, 13.6), and class III 5.0 kg (-2.3, 13.2).CONCLUSION: There was no trend in weight change after placement of the EI as BMI class increased. The greatest increase in weight occurred in the class II group at 3 years. This information will be useful in counseling obese women about the EI when discussing contraceptive options.

INTRODUCTION:The effect of intrauterine device (IUD) malposition on subsequent contraceptive choice is not well characterized. We aimed to evaluate contraceptive choice after removal or expulsion of IUDs identified as malpositioned or non-malpositioned on ultrasound imaging.METHODS:We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Data was collected via medical record review. Descriptive statistics were reported for contraceptive choice after removal or expulsion of malpositioned and non-malpositioned IUDs. Institutional review board (IRB) approval was obtained for this study.RESULTS:Of 1,759 ultrasound reports with an IUD present, 436 described malpositioned IUDs. Baseline characteristics between participants with malpositioned and non-malpositioned IUDs did not differ aside from age (30.7 and 31.9 years old respectively, P=.02). Contraceptive use after IUD expulsion or removal was available for 677 participants. Of the participants who had their non-malpositioned IUDs removed or expulsed, 29.4% used no contraceptive method compared to 19.4% of participants with malpositioned IUDs. The contraceptive implant or another IUD was used by 2.7% and 22.2% of participants after removal or expulsion of a non-malpositioned IUD, whereas these methods were used by 5.2% and 25.9% of participants who initially had a malpositioned IUD.CONCLUSION:Individuals with malpositioned IUDs had higher contraceptive use and higher use of long-acting reversible contraceptive methods after IUD removal or expulsion compared to those with non-malpositioned IUDs. This difference could be due to a difference in pregnancy desires which was not captured with this study design.

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