Use of a Pharmacy Management Service to Improve Adherence with Anti-seizure Medication Levels and Reduce Breakthrough Seizures in Pregnant Patients with Epilepsy
Abstract number :
2.539
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2024
Submission ID :
1465
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Rachel Fahey, DO – Geisinger Medical Center
Raghuveer Puttagunta, MD – Geisinger Medical Center
Cynthia Correll, MD – Cayuga Neurology
Dana Vanino, DO – Geisinger Medical Center
Rationale: Pregnancy results in several physiologic changes which alter drug pharmacokinetics. Pregnant patients with epilepsy require regular monitoring of serum anti-seizure medication (ASM) levels to ensure they are on the most effective dose to prevent seizures. Our institution has implemented a pharmacy management program since 2018 which assists with monitoring of drug levels and communicates directly with the treating provider and patient for ASM dosage adjustment needs. We hypothesize this quality improvement protocol will increase adherence to ASM levels in our pregnant patients with epilepsy, and subsequently reduce the number of breakthrough seizures during pregnancy.
Methods: This study is a retrospective analysis of a quality improvement (QI) initiative involving female patients with an epilepsy diagnosis on at least one anti-seizure medication who had a pregnancy during the review period of 2014-2024. Patients were identified as having a diagnosis of epilepsy by ICD-10 codes and an episode of pregnancy resulting in birth between the study period of January 2014 and December 2024. Once patients were identified, individual charts were reviewed to assess the adherence rates with ASM level blood draws. The minimum lab draws based on the protocol are: one pre-pregnancy, one each trimester, and one post-partum for a total of five lab draws. Additionally, charts were reviewed to assess for breakthrough seizure during pregnancy. Breakthrough seizures were classified using International League Against Epilepsy (ILAE) terminology based on description or unknown if no description was provided.
Results: A preliminary group of 181 patients were identified as meeting study inclusion and exclusion criteria. Among this group, 65 patients were identified in the pre-intervention group and 95 patients were identified in the post-intervention groups. A third group of 20 patients was also identified as having a pregnancy between 2018-2024 but were not referred to the pharmacy management service. The pre-intervention group had a median of 3 out of 5 lab draws, while the post-intervention group had a median of 4 out of 5 lab draws. Among the post-intervention group, those referred in their first trimester had a median of 5 lab draws while those referred in their second or third trimester had a median of 3 lab draws. In the pre-intervention group, 35% had breakthrough seizures during pregnancy with 15% of patients having generalized tonic clonic (GTC) seizures. In the post-intervention group, 26% of patients had breakthrough seizures with 10% of patients having GTC seizures.
Conclusions: We present a novel pharmacy management service for ASM level monitoring in pregnancy which represents an effective strategy for improving adherence to recommended lab draws and reducing breakthrough seizures in our pregnant patients with epilepsy.
Funding: No funding was received to support this abstract.
Clinical Epilepsy