Abstracts

A 1998 Epilepsy Foundation survey suggested that providers who treated women with epilepsy (WWE) were not sufficiently knowledgeable about hormonal effects on seizures, interaction between antiepileptic drugs (AEDs) and oral contraceptive pills, AED teratogenicity, infertility, sexual functioning and risk of osteoporosis. We conducted a similar survey in 2002 to assess knowledge among neurology residents in the U.S. about epilepsy-related issues in women.
The survey was mailed to 1,459 neurology residents. Demographic questions included their current year of training, primary area of interest in neurology, geographic location, and the amount of time they treated WWE. Multiple choice questions included the relationship between female hormones and epilepsy, birth defects and AEDs, interaction between oral contraceptives and AEDs, reproductive disorders, sexual dysfunction and the risk of osteoporosis in WWE. Descriptive statistical analysis was performed.
166 residents (11.4%) returned completed surveys. Of this group, 47% were in their 4^th year of training. Their primary area of interest was general neurology for 51% and epilepsy for 27%. The MD[rsquo]s role in counseling WWE about gender-specific issues was considered very important to 84% of respondents. While 97% of the residents knew the relationship between seizures and female hormones, only 39% were aware of the inhibitory effect of progesterone in the brain. Similarly, although 89% knew about the interaction between the pill and the AEDs, only 68% were correct in choosing the AEDs that exhibit such interaction. 88% residents responded that WWE on AEDs are at higher risk for osteoporosis. 9% of the respondents stated that WWE should not become pregnant while taking AEDs. Only 42% estimated correctly the risk for major birth defects and nearly half were unaware of or uncertain about the presence of reproductive disorders, lower-than-expected fertility rates, and problems with sexual dysfunction in WWE.
This survey emphasizes the MD[rsquo]s role in counseling WWE, yet highlights many areas of concern. The survey respondents were knowledgeable about hormonal effects on seizures, the interaction between contraceptive pills and AEDs and the risk of osteoporosis. Nearly 10% believed that WWE should not become pregnant on AEDs. However, there were knowledge gaps regarding the specific effect of female hormones on neuronal excitability, the percentage of birth defects associated with AEDs, sexual dysfunction, and the prevalence of reproductive disorders in WWE. While not necessarily generalizable to all U.S. neurology residents, these results suggest the need to target educational initiatives that focus on epilepsy-related issues in women to neurology residents and general neurologists entering practice.
[Supported by: Funding is provided through the Epilepsy Foundation[rsquo]s Women and Epilepsy Initiative and is supported by an educational grant from GlaxoSmithKline]