Authors :
Presenting Author: Rachel Tanenbaum, MPH – University of Tennessee Health Science Center
Michelle Bowden, MD – University of Tennessee Health Science Center
Sarah Weatherspoon, MD – University of Tennessee Health Science Center
Erin Prester, MD – University of Texas Southwestern Medical Center
Rationale:
People with epilepsy (PWE) face complex issues related to sexual and reproductive healthcare including anti-seizure medication (ASM) and contraception interactions, ASM teratogenicity risks, and socioeconomic barriers to accessing healthcare (1,2). Highly effective contraception (intrauterine device [IUD], etonogestrel implant [ENG] or depot medroxyprogesterone acetate [DMPA]) is preferentially recommended for adolescents (3). However, less effective contraception is frequently used in PWE, particularly combined oral contraceptives (COC) (1,4). Insufficient knowledge and comfort with contraceptive healthcare for child neurologists and patients are barriers to optimal use (5). At our institution, a partnership between Child Neurology and a dedicated Adolescent Medicine clinic (“Young Women’s Health Clinic” (YWHC)) provides a cohesive approach to contraception counseling and treatment for pediatric and young adult patients with epilepsy (PPWE). This study aimed to characterize contraception choices, ASM use, and neurologic co-morbidities among PPWE referred to YWHC. Methods:
A retrospective chart review of subjects with an epilepsy diagnosis referred to YWHC during 2017- 2024 for contraception counseling was performed. The following data were obtained: demographics, contraception choice, folic acid (FA), ASMs, and neurologic co-morbidities (developmental delay/intellectual disability (DD/ID), cerebral palsy (CP) and autism spectrum disorder (ASD)).
Results:
67 subjects were identified. 65 (97%) were taking ASMs at the time of the first YWHC visit. 45 (67%) had a diagnosis of DD, ID, and/or ASD; 13 with CP (19%). 18 (28%) were referred for pre-menstrual counseling. At the first YWHC visit, 36 (54%) patients were either on or then prescribed contraception. Contraception choice for that subgroup was: COC (15; 42%); DMPA (14; 39%); and ENG (3; 8%). Between the first and second YWHC visit, 10 (15%) subjects started a form of contraception.Conclusions:
This study represents a unique population of PWE, the majority with significant epilepsy co-morbidities. The contraception choices mirrored prior reports for this population, with COCs prescribed most often. A significant number of subjects were referred prior to menarche, suggesting a role for anticipatory guidance on contraception for PPWE. This study illustrates the advantage of a partnership between Child Neurology and Adolescent Medicine for PPWE.
References
1. Herzog AG, et al. Prevalence of highly effective contraception use by women with epilepsy. Neurology. 2019 Jun 11;92(24).
2. Szaflarski M. Social determinants of health in epilepsy. Epilepsy Behav. 2014 Dec;41:283-9.
3. Committee on Adolescence. Contraception for adolescents. Pediatrics. 2014 Oct;134(4).
4. Manski R, Dennis A. A mixed-methods exploration of the contraceptive experiences of female teens with epilepsy. Seizure. 2014 Sep;23(8):629-35.
5. Kirkpatrick L et al. A survey of child neurologists about reproductive healthcare for adolescent women with epilepsy. Epilepsy Behav. 2021 Jul;120.
Funding: None