Abstracts

Optimal care of pregnant women with epilepsy requires collaboration. In 2002, discussions between the Neurology and OB-GYN Departments regarding the number of pregnant women with epilepsy seen in the High-Risk Obstetrics (HROB) Clinic without established Neurology care, resulted in a collaboration aimed at benefiting those women. A clinical pharmacist (JM) would attend the HROB clinic on a monthly basis so to extend Neurology care to that population. He was supported by the collaborating epileptologists and/or epilepsy nurse practitioner., During the face-to-face interview by the clinical pharmacist in the HROB Clinic, all patients had their current drug therapy, seizure activity, presence or absence of toxicity, and medication adherence assessed. Further clinical, educational, and research interventions were suggested and documented., Over the four-years, 47 women (49 pregnancies) were interviewed by a clinical pharmacist. A majority of the women were not established patients of the Comprehensive Epilepsy Program. Nearly all women were on AED therapy at some time in their pregnancy; only 3 were not. Most women were on monotherapy with a 1^st generation AED (n=28). Six pregnancies were exposed to monotherapy with a 2^nd generation AED. Twelve pregnancies were exposed to AED polytherapy. The most frequent clinical interventions were to either make alterations to current therapy (n=10) or initiate AED therapy (n=8). Unfortunately, a lot of the latter cases were due to the patients self-discontinuing AEDs once they discovered they were pregnant out of fear of the effects on their developing baby (n=6). The most frequent education intervention was to suggest the women call the AED pregnancy registry (n=12). Other education topics were discussions on the fetal risks of seizure activity compared to AED exposure (n=8), the risks and benefits of breastfeeding (n=6) and care of a newborn by a mother with epilepsy (n=5). The most frequent research intervention was to recruit two patients into the NEAD Study. Maternal and fetal outcomes will be presented at the meeting. By retrospectively evaluating these interventions, we discovered areas for improvement. We need to better connect patients with the AED pregnancy registry and also take advantage of the clinical research opportunities in this collaborative environment., This Maternal-Fetal Medicine/Neurology collaboration is viewed very positively by all involved. We believe the ready-access to Neurology expertise in the HROB clinic has enhanced the care of pregnant women with epilepsy.,