Abstracts

Rationale: Half a million women with epilepsy (WWE) in the U.S. are of childbearing age. Among WWE who are pregnant, less than half of the pregnancies are planned and one-in-four happen after contraception failure. Many anti-seizure medications (ASMs) are teratogenic, highlighting the crucial need for adolescent WWE to receive contraception counseling. Only a third of adolescent WWE report discussing contraception with their epileptologist (Manski and Dennis, 2014). Patient and provider characteristics that impact which adolescent WWE will receive contraception counseling are understudied. We assess factors affecting whether adolescent WWE will engage in contraception, sexual activity, and menstruation (reproductive health) discussions with their pediatric neurologist.

Methods: We conducted a retrospective chart review of all adolescent females with epilepsy seen at New York-Presbyterian/Weill Cornell Medicine Center (WCMC) pediatric neurology clinics from 2018 to 2020. Patients 12-18 years-old at the time of their clinic visit were included in the study. Visit notes were reviewed by a single reviewer (CS). Data were analyzed on a visit level using generalized estimating equations (clustering by patient) and on a patient level using Chi-squared analyses and Wilcoxon tests.

Results: 219 visits among 89 unique WWE were included for analysis. There were 23 documented discussions on contraception (11% of visits) with 16 WWE (18%), 8 on sexual activity (4% of visits) with 6 WWE (7%), and 127 on menstruation (58% of visits) with 69 WWE (78%) (Figure 1a). At each visit, subjects were more likely to be counseled on contraception if menstruation (OR=7.8, 95% CI [1.9, 33]) or sexual activity (OR=10, 95% CI [1.7, 61]) were also discussed. Female providers were significantly more likely to document a discussion of menstruation (OR=3.2, 95% CI [1.6,6.4]). As age at visit increased from 12 to 18, WWE were significantly more likely to have documented discussions of contraception (Figure 1b) and sexual activity (OR=1.7 per year, 95% CI [1.2-2.4]). Similarly, WWE who had their first seizure at an older age were more likely to have documented discussions of contraception (Figure 1c) and sexual activity (documented: median age 16 years [IQR 15.3-16], not documented: median age 7 years [IQR 2-12]; z= -3.80, p< 0.001). Reproductive health counseling was not associated with the number of ASMs, changes or additions of ASMs at the visit (including teratogenic ASMs), treatment resistance, race, ethnicity, language spoken, epilepsy type, epilepsy etiology, comorbidities, or provider type (attending vs resident).