Abstracts

Rationale: Although contraception is an important consideration for women of reproductive age, there has been little investigation of contraceptive practices in women with epilepsy (WWE) in whom interactions among epilepsy, hormones and antiepileptic drugs (AEDs) may impact both seizures and contraception. The purpose of this analysis is to determine if WWE use highly effective methods of contraception and to identify factors that influence their selection. Methods: Demographic, epilepsy, AED, reproductive and contraceptive data come from the first 300 WWE, 18-47 years old, who completed a web-based survey. We performed prespecified exploratory analyses using stepwise logistic regression to determine predictors of highly effective contraceptive practices and compared frequencies using ?2 analysis.Results: The survey drew from younger, less affluent, better educated women compared to the general population; minorities (non Caucasians) were under-represented. 59.3% were having generalized convulsive, 40.7% complex partial and 27.3% simple partial seizures; 9.0% were seizure free. The current contraceptive practices of WWE and WWE at risk (potentially fertile & sexually active) are listed in Table 1. Those using more than one method were classified by the more effective method. 28.3% used no method because of sexual inactivity, desire for pregnancy, pregnancy or hysterectomy. Among women at risk, 68.0% used highly effective contraception (hormonal contraception [HC] 43.8%, IUD 15.8%, tubal or vasectomy 8.4%). Insurance (p = .005) was the only significant predictor (insurance v no insurance: 70.4% v 42.1%, p = .013). Insurance (p = .013) and AED category (p = .029) were predictors of HC use. Only 29.2% of women without insurance used HC v 52.6% with insurance (p = .030). HC use did not differ between women with commercial v government insurance (51.0% v 58.5%, p = N.S.). HC was significantly less common with EIAEDs than with NEIAEDs (37.3% v 61.3%, p = .0052) and GluAEDs (37.3% v 52.9%, p = .0609). AED category was the only significant predictor of IUD use (p = .030). IUD use was more common with EIAEDs than NEIAEDs (25.9% v 5.6%; p = .004) and GluAEDs (25.9% v 10.9%; p = .041). Age was the only significant predictor of tubal or vasectomy (p = .020) (18-27: 1.1%, 28-37: 12.3%, 38-47: 28.6%). Frequency correlated with age (p <.001). The top three reasons for selection were AED interaction (56.9%), efficacy (52.6%) and convenience (44.9%). HC users listed cycle regulation (45.4%) more often than convenience (40.7%). Cost was listed as most important by only 2.9%. Only 28.2% consulted their neurologist when selecting a method.Conclusions: The majority of surveyed WWE at risk use highly effective contraceptive methods. Safety and efficacy in WWE, however, remain to be determined. Highly effective contraception is used more often by WWE who have insurance. HC is used less often by WWE on EIAEDs. The majority make their selection without consulting their neurologist and list AED interaction and efficacy as the most important considerations. Supported in part by the Epilepsy Foundation