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Feature Article: Epilepsy in Women – Epileptologist, Dr. Olgica Laban-Grant

Dr. Olgica Laban-Grant, epileptologist who has a particularly interest in epilepsy in women sat with us to answer questions about what women who have epilepsy should know. She explained important facts about epilepsy medications in pregnant women, adjustments in epilepsy treatment when trying to not get pregnant and in menopausal women. She also told us about catamenial epilepsy and by what means doctors can better tackle epilepsy of a catamenial type. 

1) What are some of the special issues that come up for an epilepsy doctor treating women?
The effect of epilepsy and antiseizure medications on pregnancy is the first topic that comes to mind. But there are other issues that are important during the many phases of women’s lives. Epilepsy and/or antiseizure medications can have an effect on physical appearance, bone health, fertility, birth control, and sexual function.

2) Should women on birth control who have epilepsy be aware of anything in particular?
Some of antiseizure medications may decrease the effectiveness of hormonal birth control; this may result in an unplanned pregnancy.  Antiseizure medications that may cause this problem are: Phenytoin (Dilantin), Primidone (Mysoline), Carbamazepine (Tegretol, Carbatrol), and Rufinamide (Banzel). Topiramate (Topamax) and Oxcarbazepine (Trileptal) may cause this problem at higher doses. 
On the other hand hormonal birth control may decrease the concentration of Lamotrigine (Lamictal) and could result in a worsening of seizure control.
Please note, this does not mean that hormonal birth control and antiseizure medications can't be taken together. It means that your doctor may need to adjust the doses or choice of birth control methods and antiseizure medications. It is key to talk about this with your neurologist/epileptologist and gynecologist.

3) Are there any special things to consider before becoming pregnant if the mother has epilepsy?
Planning pregnancy starts almost at the time a woman in childbearing age is diagnosed with epilepsy because risks may be decreased by proper care prior to pregnancy. Both seizures and antiseizure medications during pregnancy can be risky. So both have to be carefully balanced. We know that women who have better seizure control prior to pregnancy usually have fewer seizures during pregnancy. On the other hand taking 2 or more medications, higher doses of medications and certain medications present higher risk. The patient must work closely with her neurologist/epileptologist to plan everything before trying to get pregnant. Keep in mind, over 90% of women with epilepsy will have a successful pregnancy and healthy child. This number may be even higher by planning pregnancy and decreasing known risks.

4) Some patients wonder if it wouldn't just be safer to not take the AEDs during pregnancy for the child's sake?
This decision has to be carefully evaluated prior to pregnancy. Seizures can harm both the baby and mother. Seizures during pregnancy may increase the risk of miscarriage, stillbirth, developmental delays and epilepsy in the child.  Seizures also increase the risk of falls, injuries or even accidental death. Remember, you should never stop antiseizure medications without discussing it with your doctor.

5) Should the mother not breastfeed if she is taking anti epileptic medications?
The benefits of breastfeeding to both mother and child are thought to outweigh the risks of exposure to small amounts of antiseizure medications. We know that very small amounts of all antiseizure medications will be transferred to breast milk. Most medications don't seem to cause any significant or lasting effect on baby. You may however observe sedation and less energy in the baby. Because of this, the baby’s growth and development should be carefully monitored. 

6) Some women report that they have more seizures around the time of their period?  Is this possible? Would treatment be any different for someone with this?
It is estimated that about one third of women with epilepsy have seizures that tend to cluster around their menstrual cycle.  This type of epilepsy is called catamenial epilepsy. It may occur with any type of seizures. Possible treatments include increasing doses of antiseizure medications during a particular time of menstrual cycle or supplemeting with reproductive hormones.

7) Are there any specific issues that occur when menopause (time following the cessation of menstrual periods) sets in?
Women with epilepsy experience earlier than expected menopause. The effect of menopause on seizure frequency is unclear but it may be associated with less frequent seizures, especially in women with catamenial epilepsy.  Medication doses may need to be adjusted due to changes in the metabolism. Menopause increases the risk of osteoporosis (bone weakening) and some antiseizure medications may increase this risk even more so this needs to be monitored.

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