Differences in treatment of epilepsy in pregnancy: A worldwide survey

Background: How to safely treat pregnant women with epilepsy is a question for which there are guidelines, but variations in practice exist. Methods: To better characterize how clinicians address this difficult clinical question, we distributed an anonymous survey to neurology practitioners across subspecialties and different levels of training via the Neurology®: Clinical Practice website. The survey was conducted from May 31 to December 3, 2017. We received responses from 642 participants representing 81 countries. We performed both descriptive and inferential analyses. For the inferential analysis, a multiple logistic regression model was used to analyze the effect of provider characteristics on the constructed binary outcome variables of interest. Results: The results of this survey demonstrate a wide range in the amount of folic acid recommended and the frequency of checking levels of anti-epileptic drugs. Choice of first-line agent varied by the economic development status of the respondent's country, suggesting that access to medications plays an important role in clinical decision making in many parts of the world. Conclusion: This survey highlights several areas where further research would be helpful in guiding practice.