Epilepsy and women

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Some contraceptive pills may also lead to a reduction in the level of certain anti-epileptic medicines in the blood, thus possibly leading to an increased likelihood of seizures.

Keeping a diary of epileptic seizures can reveal a relationship between seizures and menstrual cycles. This can be extremely helpful to the neurologist in adjusting the dosage of anti-epileptic medication.

Female sex hormones

Female sex hormones can affect the frequency of seizures. The number of seizures varies for some women, with the hormonal changes that occur during their menstrual cycle. This type of epilepsy is called catamenial epilepsy.

Keeping a diary of epileptic seizures can reveal a relationship between seizures and menstrual cycles. This can be extremely helpful to the neurologist in adjusting the dosage of anti-epileptic medication.

Contraception and epilepsy

Women with epilepsy can use all known forms of contraception. For the majority of women, hormonal contraception proves to be the most effective. The contraceptive method that a woman with epilepsy might choose depends on the prescribed anti-epileptic.

Anti-epileptic medications may reduce the effectiveness of contraceptives, as they affect hepatic metabolism by increasing the rate at which hormonal contraceptives are eliminated from the body, thus reducing the contraceptive effect.

Some contraceptive pills may also lead to a reduction in the level of certain anti-epileptic medicines in the blood, thus possibly leading to an increased likelihood of seizures.

Epilepsy and sexuality

Epilepsy and anti-epileptic medications do not alter sexual experience. Most epileptics have a normal sex life, though some anti-epileptic medicines may reduce libido. It is useful for a woman with epilepsy to be with an understanding partner, so that they can resolve issues with open conversation and dispel any fears of sexuality. Sexuality does not increase the likelihood of seizures. To the contrary, sexuality has a beneficial effect on self-esteem and self-image, and it reduces stress, thereby reducing the occurrence of seizures.

Pregnancy planning

Pregnancy  cause hormonal, metabolic and physiological changes in women. Pregnancy may affect the number of seizures and change the blood concentration of an anti-epileptic medicine. It is thus recommended that women with epilepsy plan each pregnancy and that a neurologist and gynaecologist are informed of the plan.

The majority of women who are treated with anti-epileptic medicines give birth to healthy children. However, it should be noted that anti-epileptic medications belong to a class of pharmaceuticals that may cause developmental disorders in the child. They can cause mild physical impairments or irregularities that are easily overlooked.

Pregnancy and epilepsy

During pregnancy, the number of seizures may increase. This is most commonly due to a decrease in the concentration of the anti-epileptic medicine in the blood. The blood concentration of anti-epileptic medication  decreases during pregnancy and returns to the baseline approximately one month after delivery.

Folic acid

Folic acid decreases the harmful effects of anti-epileptic medications. Folic acid (vitamin B9) is found in meat, leafy vegetables, legumes, nuts, seeds, oat flakes, spinach, fruit, brewer's yeast, etc. The daily requirement of folic acid is 0.5 mg. This is the amount of folic acid contained in e.g. half a cup of chickpeas, half a cup of beans and half a cup of spinach or a glass of orange juice, eight strawberries, half a cup of peas, half a cup of cooked broccoli and a bowl of lettuce. For pregnant women with epilepsy, the recommended daily allowance of folic acid is 5 mg, therefore multiply the amount of fruit and vegetables specified above by a factor of 10. Nowadays, the market offers preparations of folic acid as tablets or capsules, which facilitate ingestion of the recommended daily allowance.

Register of pregnancies

In order to learn as much as possible and find answers to the many questions about medicines, pregnancy, and maternal and child health, we collect data in registers. The registers collect data on maternal age, the types of anti-epileptic medications used, their dosages and methods of use, the types of maternal epilepsy, the number of seizures during pregnancy, side effects of anti-epileptic medications, the number of healthy birth outcomes, the number of developmental disorders, the number of spontaneous abortions and stillbirths… These data are then carefully examined and new information on the safety of medicines in pregnancy is derived. So as to maximize the information drawn from such registers, it is important to include as many pregnant women as possible, starting as early in their pregnancy as possible; by the 16th week of pregnancy at the latest.

Childbirth and epilepsy

Some anti-epileptic medicines may increase the likelihood of bleeding in both the mother and the newborn. When a possibility of bleeding exists, the pregnant woman will begin to receive vitamin K supplements for several weeks prior to giving birth. The newborn baby will also receive these supplements. Most seizures during pregnancy occur around the period of birth.

The probability of an epileptic seizure occurring during labour is actually low. Should one nevertheless occur, the medical staff will take care of the pregnant woman and the child. A caesarean section is recommended only when it has not been possible to ensure adequate control of seizures during the last trimester of pregnancy.

Breastfeeding

During the entire period of pregnancy the child receives more medication through the placenta than through breast milk. Withdrawal symptoms of the anti-epileptic medication that the child has become accustomed to during pregnancy are avoided by breastfeeding. Breastfeeding is therefore recommended for children of mothers with epilepsy.

Epilepsy and menopause

Some types of epilepsy improve during menopause and may even disappear, while other types may intensify. Seizures rarely occur for the first time in menopause.


The content of this article has been created on the basis of the “Epilepsy and Women” brochure (available in Slovenian under the title “Epilepsija in ženske”) by Dominika Novak, Boštjan Čebular, Gal Granda and Bogdan Lorber. Publisher: Medis, d.o.o.

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