Abstracts

Rationale: Antiepileptic drugs (AEDs) are prescribed to treat epilepsy, chronic headaches, neuropathic pain, and mood disorders. In women of childbearing potential (WCP) on AEDs, there is an increased risk of teratogenicity. This can potentially be reduced with folic acid supplementation. Folic acid has also been associated with higher IQ in offspring of women receiving AEDs. Folic acid prescribing patterns of neurologists who prescribe AEDs has not been robustly explored. We evaluated the rate of co-prescription of AEDs and folic acid to WCP before and after an education intervention. Methods: We screened all women seen in our General Neurology clinic staffed by residents and non-epileptologist attendings over a 3 month period. We examined the electronic medical records of female patients of childbearing potential (age < 46 years and had not undergone bilateral tubal ligation or hysterectomy) for whom an AED was prescribed. We assessed age, AED prescribed, indication, and whether folic acid was prescribed. Following the initial screen, we performed a brief educational seminar targeting Neurology residents and attendings regarding the AAN guidelines for prescription of folic acid to women taking AEDs and the clinic's performance data. A subsequent survey of all WCP seen in this clinic and treated with an AED over the following 3 months was administered. Results: During the initial 3 month survey, 54 WCP received a prescription for one or more AEDs. Mean age was 33.0+/-7.0 years. The majority (32, 59.3%) received AEDs for treatment of recurrent seizures. Minorities (22, 40.7%) received AEDs for migraine/chronic headache, pain, and/or bipolar disorder. Only 12 women (22.2%) were treated with more than one AED. Prior to the intervention, the rate of co-prescription of AEDs and folic acid was only 20.4% (11/54 WCP). This was significantly higher when neurologists were prescribing AEDs for the treatment of seizures than other neurologic disorders (11/32, 34.4% women receiving AEDs for epilepsy received a folic acid prescription versus 0/22, 0% women treated with AEDs for other conditions, p=0.02). In the 3 months following the educational intervention, 48 WCP received AED prescriptions. This cohort was similar to the pre-intervention cohort in terms of age, indication, and the percentage on dual AED therapy. After the intervention, the rate of co-prescribing folic acid to WCP on AEDs significantly increased to 64.6% (31/48, p<0.001). Neurologists prescribing AEDs for seizures continued to be significantly more likely to prescribe folic acid (19/22, 86.4%) than neurologists prescribing AEDs for other conditions (12/26, 46.2%, p=0.006). Conclusions: Without formal instruction, the prescription of folic acid to WCP taking AEDs in our General Neurology clinic was low. Co-prescription of AEDs and folic acid more than tripled following a brief educational seminar regarding the AAN guidelines. Such an intervention has the potential to improve outcomes of babies born to women on AEDs. Further studies in larger cohorts of WCP on AEDs are needed to confirm performance improvements following an educational intervention.