Rationale:
Young women with epilepsy experience stigma in many respects including reproductive health. They may not know they can have healthy children when they choose. They take anti seizure medications(ASMs) that are teratogenic, and should know they can mediate this risk by taking folate. Their birth control may be less effective due to ASMs and they may live in a region where abortion is not available if they have a pregnancy with significant anomalies. Guidelines state all women capable of becoming pregnant should be on folate. This study aims to see if child neurologists document discussion of reproductive counseling (RC) and prescribe folate to this population.
Methods:
Retrospective cross-sectional chart analysis was performed on 227 females age 12-18 with epilepsy/seizure diagnosis on ASMs seen by child neurologists at Riley downtown clinic in the first half of 2022. Data collected include: ASMs and risk category, age, intellectual disability (ID), epileptology training, folate dosing, RC. Chi squared was used for analysis.
Results:
There was no difference in folate prescription or RC between high and low/unknown risk ASMs, both around 10%. Folate was prescribed with valproate four times more often, which was statistically significant; patients taking valproate were three times as likely to get RC, which approached significance (p=0.08). In contrast, patients taking another high-risk ASM topiramate received folate less often (3% vs 15%), but this was not a significant difference; there was no difference in RC. Patients without ID are 2.5 times more likely to be prescribed folate. There was no difference in RC in this group. Patients with intractable epilepsy ( >2 ASMs) or polypharmacy ( >1 ASM) were not more likely to be prescribed folate or receive RC. Epileptologists did not prescribe folate more often than non-epileptologists. Epileptologists were less likely to document RC than non-epileptologists. There was no difference folate prescription in younger (12-15) versus older (16-18) patients, but older patients were two and a half times more likely to get RC. Folate dose varied; patients (11%) were prescribe folate. Dose ranges varied by a factor of 10, 0.4mg daily to 4mg daily, with most receiving 1mg or 4mg daily.
Conclusions:
Rates of prescribing folate to young women with epilepsy on ASMs were very low despite guidelines, regardless of ASM risk. Valproate appears to be a special case with higher rates of folate prescription and RC, unlike other high-risk ASMs. Epileptology training did not make a clinician more likely to prescribe folate. Epileptologists are less likely to document RC but this may reflect the population they treat, with more patients with ID and comorbid syndromes. Anecdotally, more RC occurs in older neurotypical patients on lamotrigine. Patients with ID may not be receiving as much RC and are not being prescribed folate at similar levels. Older teens are more likely to have received RC but not necessarily folate. Folate prescribing practices vary widely. Overall these data indicate areas where our group should discuss standardizing RC and folate practice. It also indicates clinicians may be less likely to consider patients with ID as having reproductive healthcare needs.
Funding: None