Spotlight on the February 21 issue

Predictors of unintended pregnancy in women with epilepsy

Family planning is important for women with epilepsy (WWE) in order to prevent congenital malformations. This survey found that unintended pregnancy is common and varies by contraceptive category and antiepileptic drugs (AEDs) used. Given the interactions among hormones, seizures, and AEDs, neurologists have an important role in guideline development for safe and effective contraception.

See p. 728

From editorialists Meador and Lindhout: “Unintended pregnancies are common in WWE and may exceed the risk in the general population. Given their high risk for unintended pregnancies, WWE need to be informed of issues related to differential AED risks of teratogenesis when the AED is first prescribed rather than waiting until the woman is considering pregnancy.”

See p. 724

Natural course of mild cognitive impairment in Parkinson disease: A 5-year population-based study

This study evaluated patients with incident Parkinson disease (PD) over 5 years to investigate the course and outcome of baseline and incident mild cognitive impairment (MCI). Patients with PD-MCI, including those who reverted to normal cognition, had a high risk of dementia, suggesting that early PD-MCI has prognostic value.

See p. 767

Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

Acute ischemic lesions are common in primary intracerebral hemorrhage and are associated with poor outcomes. The authors investigated the association between imaging findings and blood pressure fluctuations in patients with primary intracerebral hemorrhage. Aggressive blood pressure reductions may precipitate ischemia in patients with blood pressure dysregulation and lead to worse outcomes.

See p. 782

Burnout, career satisfaction, and well-being among US neurologists in 2016

Burnout compromises patient care by impairing physicians' well-being and contributing to workforce attrition. The authors' survey of US neurologists found that burnout was common in all practice settings and identified factors associated with burnout and career satisfaction. Optimizing workload and autonomy and decreasing regulatory and clerical burdens could mitigate neurologist burnout.

See p. 797

From editorialist Bernat: “The finding of Busis et al. that practicing neurologists have higher rates of burnout than academic neurologists may result from their greater clinical demands and less protection from market forces than their academic colleagues…The creation of means of greater professional recognition for practicing neurologists can enhance their engagement and should become a component of any physician burnout prevention program.”

See p. 726