Epilepsy is a neurologic disorder that affects both men and women, children and adults. However, women in all stages of life may need to deal with special circumstances when they have epilepsy. There are a number of epilepsy issues that are specific to women, and that may manifest at different stages of a woman's life.

Women and Epilepsy: The Facts

  • More than 90 percent of women with epilepsy have a normal pregnancy.
  • Breastfeeding is generally safe. Common reported problems occur with sedating antiepileptic drugs.
  • Women with epilepsy should have normal sexual interest, but sometimes the antiepileptic drugs may interfere with libido and could be adjusted.
  • Driving is permitted in all states after a variable period of complete seizure freedom. Typically, the waiting period is six months to one year of being seizure-free because of antiepileptic drugs.
  • Antiepileptic drugs can be associated with either an increase or a reduction in body weight, although most medications are weight neutral.

Life Stages and Epilepsy in Women

  • Puberty: The onset of certain epilepsy syndromes begins at the time of puberty. Epilepsy and menstruation influence each other.
  • Pregnancy: Epilepsy can cause hormonal problems, seizures could cause a pregnant woman to fall and hurt her unborn child, and antiepileptic drugs require precautions for pregnant women.
  • Menopause: In some women, epilepsy causes menopause to occur at an earlier age. The frequency and severity of seizures is affected by the hormonal changes of menopause.

For some women, the highest risk for breakthrough seizures (seizures that occur despite the use of antiepileptic drugs) is either at the time of ovulation or right before menses, when the estrogen/progesterone ratio is at its peak. Treatment strategies can include progesterone therapy, contraceptive therapy, variable antiepileptic drug dosing, use of benzodiazepines and acetazolamide therapy.

Effects of Epilepsy on Women
In addition to the above, the effects of epilepsy on women include:

  • A decrease in bone density. This may be a side effect of antiepileptic drugs that can alter bone mineral metabolism. This compromises bone health and produces the increased risk for osteoporosis and fractures.
  • Depression and anxiety. Just like in men, women with epilepsy frequently experience depression and anxiety. This should be discussed with medical personnel at an epilepsy center.
  • Increased psychosocial factors, including sexuality and intimacy, marriage, pregnancy, child rearing, employment and independence.

Recommendations for Women with Epilepsy

  • Women should get their recommended daily allowance of calcium and Vitamin D, and undergo a bone mineral density screening.
  • Women with epilepsy should have a discussion with their neurologist before pregnancy to make sure they are taking the safest possible antiepileptic medications.
  • All women of child-bearing age should take folic acid supplements.

Deciding which contraceptive regimen is optimal is one of the most challenging decisions. Monitor for seizure control closely and report any altered seizure patterns so that contraceptive methods and/or antiepileptic drugs can be re-evaluated.

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