Abstracts

Rationale: Over the past ten years, the care of women with epilepsy (WWE) has become specialized. The AAN issued guidelines in 2003 which have been endorsed by the AES and EFA. We evaluated how one epilepsy center practices following implementation of our electronic medical record (EMR). We previously evaluated our practice in 2009, prior to EMR. Methods: Charts of women aged 16 or older who were seen between 1/2012 and 4/2012 were selected in alphabetical sequential fashion. Retrospective review included age, imaging, EEGs, cognitive status (IQ when available), menstrual status, epilepsy type and control, history of bone density testing, pregnancy history, and the following treatment variables: AEDs, folate use and dose, calcium and vitamin D supplementation. Results: 112 charts were reviewed, including 18 pediatric and 94 adult patients cared for by seven different physicians. 71% are in the childbearing years (CB group, ages 16-45), while 19% are peri- or post-menopausal. IQ is normal to mildly impaired in 96, while 16 are moderately to profoundly cognitively impaired. 82% have partial epilepsy, 11% have JME, and 7% have other generalized epilepsies. Overall, 39% of the total sample takes folate at doses between 0.8mg and 5mg per day. In the CB group, this number is to 52%. However, among patients in the CB group with normal or near-normal IQ (NCB subgroup), folate use is 58%. Of that group, when those who had permanent sterilization or live in a closely supervised setting are excluded, folate use is 66%. Monotherapy (MT) is employed in 41% of patients. This is consistent in the CB group and in the NCB subgroup. 15% of the CB group and 13% of the NCB subgroup are on valproate. 41% of patients take calcium and vitamin D, and an additional 9% take calcium or vitamin D alone. There is no trend in terms of age and calcium or vitamin D supplementation. Of the women who have had DEXA scans, 63% are in the older age group (>45 years). 7 patients were pregnant in the 12 months prior to their clinic visit. Results were compared to prior analysis performed in 2009, which preceded the implementation of our EMR. There were not significant differences in the results on any of the above measures. Further data analysis will focus on practice differences between pediatric versus adult providers. Conclusions: Despite available guidelines for care of WWE, day-to-day practice may lag behind present knowledge. Increasingly, the literature suggests that this care should begin in the pediatric years and extend longitudinally into the golden years. The care of WWE must involve not only the treatment of epilepsy, but also a certain degree of general medical care. Implementation of the EMR should provide a more efficient mechanism for protocol-driven office visits and facilitate the tracking and analysis of longitudinal patient care practices. We found that, when compared to our practice before EMR, care for WWE had not changed significantly. This suggests that specific protocols or templates may be helpful in guiding care of women with epilepsy and optimizing attention to treatment recommendations.