Abstracts

Rationale: Over the past ten years, the care of women with epilepsy (WWE) has become specialized. The AAN issued guidelines in 2003 which have been endorsed by the AES and EFA. We chose to evaluate how one specialized epilepsy center practices in real life. Methods: Charts of women aged 16 or older who were seen between 1/2004 and 4/2009 were selected in a pseudo-random fashion, with an attempt to identify approximately equal numbers of cases for each adult and pediatric practice within the group. Retrospective review included written clinic notes, imaging, and laboratory data. Data abstracted over the five year period included age, cognitive status (IQ when available), menstrual status, seizure type, and the following treatment variables: AEDs, folate use and dose, calcium and vitamin D supplementation, and valproate history. Results: A total of 82 charts were reviewed, including 30 pediatric and 52 adult patients cared for by 7 physicians. 71% (58) were in the childbearing years (CB), while l8% were clearly documented as peri- or post-menopausal. IQ was documented as normal or borderline impaired in 42, while 21 were moderately to profoundly impaired. 92% had partial epilepsy. Overall, 40% (33 of 82) of the total sample took folate at doses between 1-4 mg. In the CB group, this number rose only slightly to 44%. However, among patients in CB group with normal or near-normal intellectual functioning, folate use rose to 54% (n=39). Monotherapy (MT) was employed in 51% of patients. For women in the CB group, 55% were on MT. Overall, only 13% were on valproate at last visit, although 38% had a remote exposure. 7% of women in the CB group were on valproate. However, only 25% of all women were on calcium and vitamin D, and there was no trend in terms of age and calcium supplementation. Of the women who had DEXA scans, 90% were in the older age groups. Further subanalysis of groups will be reported. Conclusions: Despite available guidelines for care of WWE, day-to-day practice may lag behind present knowledge. Reports from the European community within the last year have also documented that direct daily care has lagged behind the guidelines. Increasingly, the literature suggests that this care should begin in the pediatric years and extend longitudinally into the golden years. Physicians generally believe that they provide up to date, thorough care. The care of WWE must involve not only the treatment of epilepsy, but also a certain degree of general medical care. Either by default or by choice, the patient and family may expect the epileptologist to provide primary care. We do not yet have an electronic medical record (EMR) in our clinic. Implementation of the EMR this fall will provide a more efficient mechanism for protocol-driven office visits and facilitate the tracking and analysis of longitudinal patient care practices. We anticipate that this will improve compliance with accepted guidelines for WWE.