Quality care in epilepsy: Women's counseling and its association with folic acid prescription or recommendation

•The “action” of prescribing or recommending folic acid is frequently omitted.•Women's counseling does not necessarily mean folate recommendation/prescription.•Epilepsy specialist involvement does not automatically ensure optimal counseling.

ObjectiveThis study aimed to determine if annual counseling about contraception and pregnancy in the setting of treatment for epilepsy is associated with increased recommending or prescribing of folate.MethodsThis is a retrospective cohort study with medical record abstraction. We selected records from 77 women of childbearing age who had two or more visits for epilepsy at a neurology clinic. The assessment included a review of documentation from the first three visits for epilepsy within a 24-month follow-up window. We defined perfect adherence to annual counseling about the impact of epilepsy treatment on contraception or pregnancy as defect-free care for women (DFCW). A recommendation that the patient take over-the-counter folate or a prescription for folate was independently abstracted from the chart at each visit.ResultsThe group of patients who received DFCW (N = 28, 36.36%) and the group who did not receive DFCW (N = 49, 63.63%) were comparable with respect to age, disease duration, baseline history of drug-resistant epilepsy (DRE), presence of concurrent psychiatric disease, epileptologist involvement, number of antiepileptic drugs (AEDs) prescribed, seizure type, and etiology.Twenty (71.4%) patients in the DFCW group and 42 (85.7%) in the non-DFCW group were not recommended or prescribed folic acid (p = 0.12).ConclusionsEven with annual documentation of counseling about how epilepsy treatment may affect contraception and pregnancy, the “action” of prescribing or recommending folic acid during the ensuing 24 months is frequently omitted.