Authors :
Presenting Author: Matthew Mashayekhi, DO – University of Connectciut School of Medicine
Laura Kirkpatrick, MD – University of Pittsburgh
Maria Kristina Dorotan, MD – Yale School of Medicine
Sarah Lindsay, MD, MSc – Hartford Healthcare Medical Group
Paula Voinescu, MD, PhD – Brigham and Women’s Hospital, Mass General Brigham, Harvard Medical School
Jessica MacIntyre, BS – University of Connecticut School of Medicine
Emily Shearier, PhD – Hartford HealthCare
Ya-Hue Li, PhD – Hartford HealthCare
Anumeha Sheth, MD – Hartford HealthCare Ayer neuroscience institute Comprehensive Epilepsy Center
Rationale:
Antiseizure medications (ASMs) and hormonal contraceptives have known interactions requiring nuanced management. Modulation of hormones, using hormonal birth control, could reduce seizures in PWECP with catamenial seizure exacerbation (CSE). Currently there is no evidence for optimal contraception method in People with Epilepsy of Child-bearing Potential (PWECP). This abstract presents single center data from Hartford HealthCare (HHC) from a survey of contraception practices in PWECP. The aim of this study is to better understand the patterns of contraception use in PWECP and the perceived effect of contraception on seizure frequency.
Methods:
This is a cross-sectional survey derived from the National Survey of Family Growth (NSFG), a validated questionnaire publicly available on the Centers for Disease Control and Prevention (CDC) website. Additionally, epilepsy and ASM-related questions were added from another validated questionnaire- Knowledge of Women with Epilepsy (KOWIE). The survey underwent cognitive interviewing from PWECP and content validity assessments by reproductive health and epilepsy experts. Incorporating NSFG questions allows benchmarking of the results to the general female U.S. population.
Eligible participants were women aged 18-47, diagnosed with epilepsy for at least one year and currently on daily ASMs, from a single center. Results:
Data from 102 respondents was analyzed (table 1). 54/95 (56.8%) of respondents reported receiving counseling regarding contraception from a health care professional in the past 12 months. 41/95 (43.2%) respondents were aware that some ASMs may decrease the efficacy of contraception. 9/102 (8.8%) participants reported using contraception to prevent seizures.
The most common antiseizure medications used were levetiracetam, 54/102 (52.9%), and lamotrigine 35/102 (34.3%) (Table 2). Oral contraceptive pills (OCPs) 23/95 (22.5%) followed by intrauterine device (IUD)18/95 (17.6%) were the most common form of contraception used by PWECP in the sample (Table 2). Contraception data from our center was compared to data from the NSFG. A statistically higher number of PWECP used depot medroxyprogesterone acetate (9.8% vs 3.3% p=.0003%) and etonogestrel implant (8.8 % vs 3.8%) in our sample as compared to the NSFG population. 2/16, 3/10, 1/18 respondents using OCP, Depot Medroxyprogesterone acetate and IUD respectively reported that contraception reduced their seizure frequency.
Conclusions:
These results suggest that there are gaps in contraception counseling and awareness among PWECP. OCPs are the most commonly used contraceptive in PWECP as well as the NSFG. Use of depot medroxyprogesterone acetate and etonogestrel implants was higher in our sample than in the NSFG.
This project will be expanded to multiple sites across the United States to obtain large-scale data. Findings from this work will inform future efforts to determine optimal contraceptive strategies for PWECP.
Funding: N/A