Rationale:
People with epilepsy of childbearing potential (PWECP) have increased pregnancy risks and risks for fetal complications. Folic acid (FA) supplementation is associated with decreased risk of neural tube defects, miscarriage and preterm birth. Improved neurocognitive outcomes have been observed in offspring of PWECP who received folate supplementation. In 2009, American Academy of Neurology (AAN) practice guidelines recommended FA supplementation pre-conception and during pregnancy to PWECP (Harden CL et al., 2009). Updated guidelines in 2024 recommend at least 0.4 mg of FA daily (Pack AM et al., 2024). AAN guidelines advise counseling at least yearly regarding how epilepsy and its treatment may affect contraception and pregnancy. This study evaluates whether subspecialty and general neurology practices meet guidelines for supplementation of FA in PWECP. We aim to determine if there is a difference in folate supplementation guideline implementation between epilepsy subspecialty and general neurology practices at our center. We also investigate clinical scenarios and encounter types for which folate supplementation was not documented.
Methods:
This study is a retrospective review of patients seen in our center’s epilepsy specialty and general neurology teaching practice between 5/1/2024-10/31/2024. Inclusion criteria included all female patients, ages 15-45, with ICD-10 diagnosis codes for seizure, focal epilepsy, generalized epilepsy, and epilepsy unspecified. Six epilepsy faculty and one specialty nurse practitioner (NP) were included from the epilepsy practice. All resident trainees and one general NP were included from the general neurology practice. Chart reviewed was performed, including visit notes and medication lists, with word search for "folic acid", "folate", "multivitamin", and "prenatal vitamin.”
Results:
There were 266 distinct encounters in the epilepsy specialty practice and 27 in the general neurology practice. Ages ranged from 18-45 for the epilepsy group and 21-44 in the general neurology group. FA supplementation was documented in 79.32% of epilepsy subspecialty encounters and 18.52% of general neurology encounters. Potential contributing factors when documentation of FA supplementation was not present included suspected functional neurologic disorder (FND), provoked seizures, definitive contraception, device programming visits, or was uncertain. In the general practice, a greater number of encounters were staffed by non-epilepsy faculty (22 of 27 encounters).
Conclusions:
There was a difference in documentation of FA use in PWECP between specialty epilepsy and general neurology practices. Documentation of FA supplementation occurred more often in the epilepsy specialty practice suggesting need for education of patients and physicians for use and documentation in the general practice. In cases where no FA was documented, clinical scenarios included provoked seizures, FND, device visits, and staffing by non-epilepsy specialists. Study limitations included a smaller portion of PWECP seen in the general practice.
Funding: No funding received in support of this abstract.