Authors :
Presenting Author: Muhammad Zahid, DO – Mercy Health - Toledo
Anderson Shemme, MD – Michigan Medicine; Queen Bolden, . – Michigan Medicine; Patty Johnson, . – Michigan Medicine; Missy Plegue, MA – Michigan Medicine; Linda Fletcher, CPNP – Michigan Medicine; Sarah Clark, MPH – Michigan Medicine; Nicholas Beimer, MD, FAES – Michigan Medicine; Sucheta Joshi, MD, FAES – Michigan Medicine
Rationale:
Folic acid (FA) supplementation prior to and during early pregnancy has a well-established role in prevention of neural tube defects. This is significant in women with epilepsy (WWE), as certain anti-seizure medications (ASMs) alter FA metabolism, decreasing blood FA levels. Despite extensive counseling and educational campaigns, FA supplementation in WWE remains suboptimal. Studies have shown low FA adherence rates in WWE from 15.5%-63.9%. We sought to assess the relationship between patients at transition age prescribed FA and patient/caregiver knowledge of reproductive issues in epilepsy.
Methods:
We evaluated a sample of 147 female patients enrolled in the Michigan Medicine Epilepsy Transition registry, of whom 122 were taking ASMs. We included patients with psychogenic non-epileptic seizures (PNES) who were taking ASMs for indications other than epilepsy. This registry consists of patients ages 16-26 who are transitioning from pediatric to adult epilepsy providers. Patients and caregivers complete Epi-TRAQ, a validated Epilepsy Transition Readiness Assessment questionnaire to assess knowledge and competency of transition related epilepsy issues. Epi-TRAQ includes questions on the impact of epilepsy and ASMs on pregnancy and contraceptive medications (Figure 1).
Results:
Of the 122 patients taking ASMs, 89 (73%) were documented to have been taking FA. 33 (27%) were either not taking FA or had unknown adherence (e.g., not specifically documented in notes or not listed in medication list). Between patients taking FA and not taking FA, there was no difference in knowledge of how seizures affect pregnancy (
p = 0.683) or how ASMs and birth control medications affect one another (
p = 0.731).
Conclusions:
FA supplementation in WWE is suboptimal. Our patient population of transition age adolescents and young women on ASMs demonstrated that 73% were prescribed FA, higher than seen in previous studies. Furthermore, there was no correlation between FA supplementation and patients’ knowledge of reproductive health and pregnancy in relation to epilepsy and ASMs. Our analysis suggests that despite comparable Epi-TRAQ scores for both groups, there is a knowledge gap regarding the importance of FA supplementation. The transition period during transfer of care from pediatric to adult neurology/epilepsy is a critical time for clinicians to intervene and reinforce the importance of health care issues such as FA supplementation. While Epi-TRAQ serves as a useful screening tool to assess transition readiness, adequate scores around reproductive issues are not enough to ensure FA intake and could be falsely reassuring. Regular reinforcement and additional education around the importance of FA supplementation is needed for this patient population.
Funding:
This work was funded by a Pediatric Epilepsy Research Foundation Infrastructure/Registry Grant.