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Knowledge of neurologists and patients with epilepsy about the risk of drug interactions between anticonvulsants and contraceptive methods

Grant number: 13/19568-7
Support type:Scholarships in Brazil - Scientific Initiation
Effective date (Start): April 01, 2014
Effective date (End): November 30, 2014
Field of knowledge:Health Sciences - Medicine
Principal Investigator:Carolina Sales Vieira
Grantee:Giuliano Roberto Scarpellini
Home Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

Epilepsy is a neurological syndrome characterized by recurrent seizures, with prevalence from 0.3 to 1% of the world population. This disease causes a greater impact on quality of life of women, mainly due to the effects of anticonvulsant drugs (ACD) on the different phases of the menstrual cycle and woman's life.The gestation period is one of the stages of a woman's life that is most relevant. During pregnancy, there remains a balance between the risks of using the ACD and the benefits of adequate seizure control. The ACD has teratogenic potential, and potential increased risk of bleeding in the newborn. From 17,3% to 35% of patients show an increase in the number of seizures during pregnancy.Pregnancies in women with epilepsy are a potential risk thus the pre-conception counseling is indicated. In this scenery contraception is particularly important to these patients. It is estimated that the incidence of unintended pregnancies is 50% in women using ACD.The ACD may have drug interactions with hormonal contraceptives that can cause the contraindication of these methods in some cases. This is because both the ACD as the steroid hormones have hepatic metabolism via cytochrome P450, some ACD can induce microsomal enzymes may impair the effectiveness of contraceptives. Also another route of metabolism is via the biliary and renal excretion which can be stimulated by ethinyl estradiol contraceptives and lead to reducing the effects of ACD.Despite the importance of understanding the interactions between the ACD and contraceptive methods many doctors and patients are not aware of them. Older studies indicate less knowledge of the effects of ACD on contraception, featuring up to 4% of neurologists and obstetricians 0% with appropriate responses. This was assessed in questionnaires involving different aspects of the fertile period of a woman's life, assessing knowledge related to hormonal interaction with seizures, effects of ACD on contraception, use of ACD during pregnancy among others. Already in more recent studies, there was an increase in the percentage of health professionals with expertise in this regard, ranging from 33% to 71% of professionals interviewed.ObjectivesAssess knowledge of neurologists on reproductive planning of women with epilepsy using anticonvulsants. Assess knowledge of epileptic womens using anticonvulsants about their reproductive planning.Material and methodsThis is a descriptive study, will be assessed all neurologists in the city of Ribeirão Preto, in public and private health care through structured questionnaires. In addition, will be interviews with epileptic womans in use of ACD from public and private network. For the sample of patients, we will consider only women of reproductive age, in this sense, considering the prevalence of epilepsy of 0.3% and the number of women aged 18 to 45 years in Ribeirão Preto, 350 patients will be included. Of these, 80% are of the NHS and 20% will come from additional health clinics (private and health plans).The questionnaires will be administered by a researcher without prior consultation time.