Abstracts

Rationale: Women with epilepsy (WWE) of child bearing age require expertise not only in treatment of their epilepsy but also effective family planning in order to minimize risks of teratogenesis and drug-drug interactions between hormonal contraception and antiepileptic drugs (AEDs). Despite the need for carefully planned pregnancies in WWE, many pregnancies in this population are unplanned and many do not use highly effective forms of contraception (Davis and Pack). Enzyme- inducing AEDs can lead to failure of most forms of hormonal contraception and hormonal contraception containing synthetic estrogens can decrease the efficacy of certain AEDs including lamotrigine The US Medical Eligibility Criteria for Contraceptive Use (MEC) developed by the Centers for Disease Control and Prevention provide guidance in addressing the contraceptive needs of women with epilepsy. Long acting reversible contraception, such as the intrauterine device (IUD), have been identified as an ideal family planning option for women with epilepsy given its high efficacy and avoidance of interactions with AEDs. Despite the benefits, this method of contraception has low utilization rates in the United States. Many WWE have reduced access to both epilepsy and family planning care in part due to seizure frequency and dependency for transportation.Methods: To address these challenges, a collaborative clinic between the Family Planning Division of the Department of Obstetrics and Gynecology and the Epilepsy Section of the Neurology Department at the University of California, Davis has been created. Clinic encounters of consecutive women of child bearing age seen in this monthly clinic from 6/2014 - 5/2015 (n=23) were reviewed for demographic data, epilepsy classification, seizure frequency, AED prescribing, and contraceptive plan before and after the clinic visit. A two tailed Mann-Whitney Test was performed to evaluate the impact of interdisciplinary care.Results: Demographics are summarized in table 1. Approximately 70% of patients were prescribed AEDs that interaction with current use of hormonal contraception. 9% had recently suffered seizures attributed to drug-drug interaction. Contraceptive methods prior to the clinic appointment (Figure 1) consisted of barrier methods in 61%, hormonal contraception in 19%, and LARCs in 11.5%. Following the encounter, contraception choice was 13% electing for barrier methods or considering their choice, 16.2% for hormonal contraceptives, and 40% electing for LARCs. p-value = 0.0007, Z-Score = -3.3942.Conclusions: In this series, a significant shift to more effective contraceptive methods has been demonstrated when family planning specialists collaborate with epileptologists. For those who are prescribed AEDs and hormonal contraception, this clinic allows for early identification and management of drug-drug interactions to minimize risk of failure of either therapy. Future efforts of this clinic plans to provide capacity for LARC placement during the encounter and preconception counseling and planning with access to maternal fetal medicine.