Treatment of Women With Epilepsy

Alison M. Pack, MD, Martha J. Morrell, MD

Disclosures

Semin Neurol. 2002;22(3) 

In This Article

Abstract and Introduction

Abstract

Epilepsy is equally prevalent in men and women. However, for women there are unique concerns related to hormone effects on seizures and the effects of seizures and antiepileptic drugs (AEDs) on reproductive health. Steroid hormones affect neuronal excitability and seizure frequency. Some AEDs reduce the efficacy of oral contraceptive agents, increasing the probability of unplanned pregnancies. AEDs affect bone density. AEDs may alter reproductive hormones resulting in polycystic-appearing ovaries, anovulatory cycles, and infertility. Seizure frequency may change during pregnancy, seizures may cause pregnancy complications, some AEDs are teratogenic, and many cross into breast milk. The treatment of a woman with epilepsy must consider all these issues.

Objectives: On completion of this article the reader will understand the role of cytochrome P450-inducing antiepileptic drugs in oral contraceptive failure, the effects of AEDs on bone mineral density, the effects of seizures and AEDs on fertility, and the principles of AED use in pregnancy and breast feeding and will have an approach to the treatment of catamenial seizures.
Accreditation: The Indiana University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit: The Indiana University School of Medicine designates this educational activity for a maximum of 1.0 hours in category one credit toward the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.
Disclosure: Statements have been obtained regarding the authors' relationships with financial supporters of this activity. There is no apparent conflict of interest related to the context of participation of Dr. Pack. Dr. Morrell has received grant support from Abbott Laboratories, Novartis, GlaxoSmithKline, and is a consultant for GlaxoSmithKline, UCB, Abbott Laboratories, Novartis, Pfizer, and OrthoMcNeil.

Introduction

Although epilepsy is equally prevalent in men and women, the management of women with epilepsy includes specific challenges, such as hormonal influences on seizure presentation, the interaction of antiepileptic drugs (AEDs) and oral contraceptive agents, and the effect of AEDs on bone density and reproductive health. In addition, women with epilepsy need to understand the potential effects of seizures and AEDs on the developing fetus and take steps to minimize fetal risk.

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