Abstract Details

Title AAN Epilepsy Quality Measures: Electronic Medical Record Documentation of Folic Acid and Contraceptive Method Use in Women of Childbearing Age Taking Valproic Acid Referred for Electroencephalography

Topic Epilepsy

Presentation(s) (-)

Poster/Presentation
Number 001

Objective

Background Valproic acid (VPA) carries a higher risk of fetal malformations than other antiepileptic (AED) medications. Women of childbearing potential while taking VPA may need counseling, contraception and should take FAS. Using the EMR may be one way to monitor if care of these women is adequate.

Design/Methods Outpatient EEGs in 2 University of Texas Southwestern hospitals and Parkland Memorial Hospital in Dallas Texas recorded from 1-1-2010 to 10-15-2012 were reviewed (6884 records). Included in this study were women taking VPA who were born between 1-1-1968 and 1-1-1996. The EMR was reviewed for use of contraception and/or folic acid at the time of the EEG. If surgically sterilized, no FAS was required for appropriate care. Abstinence was considered a form of contraception, but FAS was considered necessary in such cases or in cases with other forms of contraception. Notes near the time of the EEG were reviewed for evidence of counseling about VPA risks.

Results There were 76 EEGs in 53 women taking VPA at the time of their EEG. 31/53 women were appropriate with FAS and 36/53 had EMR documented medical/surgical contraception or abstinence. Overall, 25/53 (47%) of women taking VPA had both adequate contraception and appropriate FAS.

Conclusions AAN Epilepsy Quality Measures (Neurology® 2011;76:94-99) recommend that women 12-44 years of age be counseled about antiepileptic drug treatment effects on contraception and pregnancy. This study of women on VPA presenting to a large multi-hospital EEG laboratory showed that there is room for improvement in documenting appropriate care. While it is possible that women were counseled or treated with contraception or FAS, without documentation, the AAN Epilepsy Quality Measure was unmet.

Authors/Disclosures
Paul C. Van Ness, MD, FAAN (Baylor College of Medicine) PRESENTER	No disclosure on file
Puneet K. Gupta, MD (Neurology Consultants of Dallas, PA)	No disclosure on file
Ryan Hays, MD, MBA, FAES, FAAN (UT Southwestern Medical Center)	Dr. Hays has nothing to disclose.
Mark Agostini, MD (U.T. Southwestern Medical Center)	Dr. Agostini has nothing to disclose.
Pradeep N. Modur, MD (Seton Brain & Spine Institute, University of Texas)	No disclosure on file
Darryl C. De Vivo, MD, FAAN (Columbia University)	Dr. De Vivo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen and Novartis. Dr. De Vivo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aspa Therapeutics.

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