Abstracts

Rationale: Women with epilepsy (WWE) require specialized contraceptive counseling. There are important interactions between many anti-epileptic drugs (AEDs) and hormonal contraception. In 2008, the World Health Organization recommended the use of an intrauterine device for female patients taking enzyme-inducing anti-epileptic drugs, topiramate and lamotrigine (Gaffield et al.). It is also a highly effective form of contraception for other WWE. WWE require effective contraceptive counseling but there are no guidelines on who should deliver these recommendations. The objective of this study was to explore the association between IUD specific counseling by neurologists and patients' contraceptive choices.Methods: We conducted a retrospective chart review of female patients age 18-44 seen by the Northwestern epilepsy clinic between 2010 and 2014. For inclusion, patients must have had 4 follow up visits. Pregnant patients and patients planning pregnancy were excluded. Chi Squared and Fish Exact tests assessed associations between IUD specific counseling and patient contraceptive choice.Results: Seventy-nine female patients met criteria for inclusion. Twenty-eight percent were never counseled about birth control, 40.5% were generally counseled about contraception without mentino of an IUD and 31.6% were counseled with a specific recommendation for an IUD. Groups did not differ by AED drug class. Women who received IUD specific counseling were significantly more likely to switch to an IUD (60%) compared to non-specifically counseled women (19%) and to those who received no counseling (9%) (N=79, p=0.000158).Conclusions: Neurologists specific mention of an IUD is significantly associated with the patient acquiring an IUD. This suggests that Neurologists have an important role in patients' contraceptive choices.