Women with Epilepsy
Women with epilepsy know that there are many gender specific issues related to epilepsy. Research has shown a direct link between hormones and seizures. A woman's hormone level will change during her periods, pregnancy, and throughout menopause. These changes can affect when and how often a woman has seizures; they have also been known to affect when a woman stops having seizures.
One third to one half of women with epilepsy will notice a pattern between their seizure frequency and their menstrual cycle. This may well be attributed to changes in hormone levels. Estrogen and Progesterone are two hormones produced in a woman's body. Among their many affects, these hormones speed up and slow down brain cell activity which, in turn, changes the number of seizures some women experience. When estrogen levels are high and progesterone levels are low, the chances of having a seizure greatly increase.
Some women only experience seizures, or experience an increase in seizure activity, during certain points in their menstrual cycle. They may find that their seizures tend to happen just before or during their period, and some may experience a higher rate of seizures after menstruation. This is called Catamenial Epilepsy. These seizures can be hard to control, but your family doctor or neurologist can help. Seizure activity in Catamenial Epilepsy can be exacerbated by factors such as alcohol, stress, and lack of sleep.
Women have a larger selection of birth control methods than ever before. As a woman living with epilepsy, it is important to choose a birth control method that does not interact with your Anti-Epilepsy Drugs (AEDs).
The Combined Oral Contraceptive Pill or "the pill" is commonly used around the world as the most effective form of birth control. There are risk factors for all women, such as age, weight, smoking, etc., but women living with epilepsy face additional, controllable risks. Some anti-epileptic dugs are enzyme-inducing, meaning they speed up the way the liver breaks down the pill, which may reduce its effectiveness. Therefore, it is imperative to choose a pill that is not enzyme-inducing. Remember: the pill is never 100% effective, so it is always a good idea to use a back-up method of birth control such as a condom. The chart below shows which AEDs are enzyme-inducing (should be avoided) and non-enzyme-inducing:
Epilepsy drugs which do reduce the effectiveness of the Pill (enzyme-inducing drugs):
Non-enzyme inducing drug:
Epilepsy drugs which do not reduce the effectiveness of the Pill:
* Lamotrigine is a non enzyme-inducing drug. However, unlike other enzyme-inducing drugs, it can affect how well the contraceptive pill works and vice versa. This means both medications are reduced in effectiveness and should not be used together.
Morning After Pill
Women taking enzyme inducing drugs will need to take a higher dosage (approximately 50%) of the morning after pill when compared to the standard dosage. It is advisable to check with your doctor about appropriate dosage levels to counteract the effect of your AED.
Some studies have shown a slight decrease in fertility found in women who have epilepsy. Fortunately, this effect is most often quite treatable through the use of fertility drugs. Using AEDs does not prevent a woman from receiving fertility treatment. A few women will notice a marginal increase in the number of seizures they experience while taking fertility drugs.
There is no reason why a person with epilepsy cannot have a healthy and normal pregnancy. It is a good idea to talk to your doctor before conception to plan for the child and discuss your epilepsy and medications. Pre-conception counseling with your doctor and neurologist can be very helpful. Women with epilepsy tend to have a slightly higher incidence of having a baby with a problem, which may be related to either AEDs or the epilepsy itself.
It is important that you arrange a counseling appointment as soon as you become aware that you are pregnant.
Seizures during pregnancy
Approximately 50% of pregnant women with epilepsy notice an increase in the frequency and severity of their seizures, the other half notice no apparent change. The reasons cited for these changes are a dramatic shift in hormonal levels, changes in body fluid and salt retention, and changes in the way the body absorbs, distributes, and dilutes anti-convulsant drugs. These bodily changes usually return to normal about 3 months after delivery.
As stated above, these dramatic changes in metabolism have a great impact on the effectiveness of AEDs; therefore, it is vitally important to visit a physician throughout pregnancy and 3 to 4 months postpartum. AED dosage levels must be monitored carefully and adjusted when necessary, along with frequent blood level measurements.
Possible complications during pregnancy
Pregnant women with epilepsy are often identified as having "high-risk" pregnancies. Doctors feel that there is a greater chance of complications to both the mother and fetus; therefore, extra precautions should be taken throughout the pregnancy. There are several complications that can arise in some women during pregnancy.
Placental problems figure more prominently in women with epilepsy. Premature separation of the placenta (abruptio placetae) may occur, and the accompanying vaginal hemorrhage may severely inhibit the nutrition of the developing fetus.
Anti-Epileptic Drugs and pregnancy
Since all drugs present a possible danger to women during pregnancy, women must be aware of the risks posed by AEDs. If you do become pregnant, it is important not to discontinue your AEDs; the chances of having a seizure and injuring the baby (perhaps from a fall) will become much higher and out-weigh the risks of the drugs. Pregnant women not taking AEDs, but who were previously taking AEDs for childhood epilepsy (but eventually outgrew it), have a 4 in 100 chance of having a child born with birth defects. Pregnant women controlling seizures through the use of AEDs will have a 6 in 100 chance of having a child with a birth defect. In both cases, women with epilepsy have over a 90% chance of producing a perfectly healthy baby.