Abstracts

Rationale: The importance of folic acid supplementation in women of childbearing age who are taking antiepileptic drugs (AEDs) has been an emerging issue within the last 10 years. Many AEDs cause abnormal metabolism or decreased absorption of folic acid. It has been shown that low maternal serum folate levels correlate with a higher incidence of fetal malformations, specifically neural tube defects. While there is no consensus on the exact dose, folate supplementation for this group of women is considered standard of care. The American Academy of Neurology as well as the American College of Obstetricians recommend that women of childbearing age with epilepsy on one or more AEDs be supplemented with at least 0.4mg of folic acid daily. Methods: Retrospective chart review examining folic acid supplementation in women of childbearing age who have been treated for epilepsy with one or more AEDs at a large academic Neurology practice from 2002-2009. For the purposes of this study, childbearing age was defined as between 13 and 45 years of age. All races and levels of cognitive ability were included. Exclusion criteria included women with history infertility procedure such as bilateral tubal ligation or hysterectomy and women never seen by a neurologist at MUSC. 100 charts that met inclusion criteria were included in analysis Results: Our findings show that only 26% of selected women were supplemented with folic acid. Of these women, the age range was from 21 to 43 years of age with an average age of 28. The women that were taking folate were supplemented with a dose of 1-4mg daily. The drug most associated with folate supplementation was Levetiracetam. The use of folate was more common in women taking Levetiracetam or Lamotrigine than those taking Valproate or Carbamazepine. Conclusions: We have identified an area for quality improvement regarding folic acid supplementation in women with epilepsy. Our results indicated most women that were taking folic acid were in early adulthood. While this is a common age for planned pregnancies, it is important to recommend beginning folic acid supplementation during adolescence or teenage years and continuing supplementation through middle adulthood. The more frequent use of folate in women taking Levetiracetam or Lamotrigine may reflect more recent initiation of therapy or current trends in treatment