Abstracts

Rationale: Over a million women with epilepsy (WWE) are of childbearing age in the USA. This population requires careful consideration of not only type of antiepileptic drug (AED) but also anticonception  and pregnancy planning (Voinescu & Pennell 2015). There is evidence that little information is provided to WWE considering these issues leading to unplanned pregnancies and its consequences. In this work, we aimed to evaluate sexual function, behavior and, contraceptive practices of WWE followed at tertiary care centers in Brazil  Methods: We carried out a prospective study of 100 WWE, with ages ranging from 15 to 45 years (mean age 33.5 years), followed at two tertiary care centers. Epileptic syndromes were diagnosed according to ILAE criteria (Scheffer et al., 2017). Seventy-five patients had drug-resistant epilepsy and used polytherapy. We applied a standard questionnaire that evaluated sexual life, contraception, counseling and, risk of unplanned pregnancy. Exclusion criteria were intellectual disabilities, major psychiatric disorders, use of psychoactive drugs, lack of school attendance and any condition that would prevent the completion and comprehension of the survey applied Results: Sixty-six (66%) WWE used one reversible contraceptive method. The most frequently contraceptive method used was: systemic hormonal contraception - oral (36/66[23.76%] patients) and non-oral (16/66 [10.56% patients). Seven (4.62%) patients used intra-uterine dispositive and, seven (4.62%) used only condom, not associated with other contraceptive methods. Two (2%) WWE opted for an irreversible contraceptive method (tubal ligation).The remaining 32 (32%) women did not use any type of contraceptive methods, including barrier methods, for contraception or STD prevention. From this group, three (9.37%) WWE intended to get pregnant.Twenty-six (26%) patients reported no active sexual life.Fifty-four patients (54%) reported that epilepsy was a determinant factor in deciding whether or not to use contraceptive methods, as well as which method would be used.Guidance regarding contraception was obtained with a general practitioner (10%), gynecologist (50%) and neurologist in charge for the patient (6%). Forty-four patients obtained information with others, such as friends/families, Internet and support groups.Twenty-seven patients were considered at risk for unplanned pregnancy, taking into account the presence the active sexual life associated with the irregular or not use of contraceptive methods.  Conclusions: Most women with epilepsy used methods for contraception that do not take into account the interaction with antiepileptic medication. IUD, the first option for women with epilepsy, was used by a small group of patients. The authors believe that this is a consequence of improper guidance received by these patients. Furthermore, one quarter of our sample did not report active sexual life probably related to the social isolation determined by epilepsy since most patients had drug-resistant epilepsy. Women with epilepsy remain as neglected group regarding contraceptive counseling and are at risk for unintended pregnancies. Funding: No funder was received