Women with epilepsy may face unique challenges
Epilepsy is a neurological disorder that affects both men and women. However, there are a number of epilepsy issues that are specific to women, and they may manifest at different stages of a woman's life.
Anti-epileptic drugs and women
Anti-epileptic drugs (AEDs) are a treatment for many people with epilepsy. AEDs are a type of medication that aims to stop seizures from happening.
- Breastfeeding is generally safe. Common reported problems occur with sedating anti-epileptic drugs.
- Women with epilepsy should have normal sexual interest, but sometimes the anti-epileptic 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 anti-epileptic drugs.
- Anti-epileptic drugs can be associated with either an increase or a reduction in body weight, although most medications are weight neutral.
The relationship between epilepsy and women's life stages
- Puberty: The onset of certain epilepsy syndromes begins at the time of puberty. Epilepsy and menstruation influence each other. For some women, the highest risk for breakthrough seizures (seizures that occur despite the use of anti-epileptic 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 anti-epileptic drug dosing, use of benzodiazepines and acetazolamide therapy.
- Pregnancy: More than 90 percent of women with epilepsy have a normal pregnancy. However, epilepsy can cause hormonal problems, seizures could cause a pregnant woman to fall and hurt her unborn child and anti-epileptic 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.
Effects of epilepsy on women
In addition to the above, the effects of epilepsy on women may include:
- A decrease in bone density. This may be a side effect of anti-epileptic 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.
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 anti-epileptic 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 for women with epilepsy. Monitor for seizure control closely and report any altered seizure patterns so that contraceptive methods and/or anti-epileptic drugs can be re-evaluated.