Epilepsy impacts everyone differently, however in some cases women may have to consider additional measures to ensure their safety. Within this blog, we will be discussing specific impacts seizures might have throughout a woman’s lifetime.
One of the most women-specific experiences around epilepsy is a diagnosis called catamenial epilepsy. Catamenial epilepsy can be defined as a worsening of seizure frequency around menstruation. This is theorized to be related to a drop in progesterone during menstruation, and it affects about 1/3 of women1. Adjusting anti-seizure medications (ASM) and contraceptives around this time can assist with lessening the frequency of seizures around this time.
Drug interactions between many ASMs and oral contraceptives such as birth control pills have also been seen. In some cases, ASMs can lessen their efficacy, in other words, make birth control pills less effective, potentially causing an unplanned pregnancy. Alternative contraceptive options may be recommended to improve efficacy and lessen the risk of unplanned pregnancy such as barriers, to further limit the risk of unwanted pregnancies. In some cases, birth control pills can also potentially reduce the efficacy of the anti-seizure medication causing more seizures, particularly with lamotrigine2. Options such as an intrauterine device (IUD) or Depo-Provera, which can be administered via an intramuscular injection every three months, are often recommended by neurologists and OB-GYNs to avoid the above interactions and improve efficacy.
Another consideration for women who have seizures is the risks related to seizures versus taking ASMs while pregnant. Convulsive seizures during pregnancy have been linked to higher rates of miscarriage, fetal distress, low birth weight, premature births, developmental delay and rates of deaths of both mother and child4. However, most women with epilepsy can have safe and healthy pregnancies when followed closely by a neurologist and OB when medications are optimized. Lamotrigine and levetiracetam have the best safety data during pregnancy and risks of continued seizures far outweigh the risks of taking these medications. On the other hand, there are some medications like valproate and phenobarbital that are not recommended for women considering pregnancy given high rates of congenital malformations5. Women on multiple ASM’s also have higher rates of major congenital malformations6. Major congenital malformations are structural abnormalities with surgical, medical, or cosmetic importance such as cleft palate or lip, spinal bifida, hip dysplasia, and many heart or lung conditions7. Because of this, plans for future pregnancy should be discussed with healthcare providers at the time of epilepsy diagnosis and throughout a woman’s reproductive years to optimize seizure control and plan for a healthy pregnancy if desired and minimize risks. For example, folic acid supplementation is recommended before and during pregnancy to reduce the risk of cognitive delay in children of women with epilepsy3. Extra monitoring is required during pregnancy to limit complications and ensure the health of the mother and child. This often includes tracking medication levels to ensure proper levels are maintained, by adjusting ASM doses when needed throughout the pregnancy as metabolism increases, in order to continue keeping seizures controlled9.
Breastfeeding is an area of postnatal concern for many new moms, especially those who have epilepsy and are on ASMs. However, breastfeeding while on anti-seizure medication is recommended since the benefits of breastfeeding outweigh the risks8,11. Children of women with epilepsy on ASMs who were breast fed had higher IQ scores up to 6 years of age when compared to children of women with epilepsy on ASMs who did not breastfeed10. The American Academy of Neurology and the American Academy of Pediatrics advise that women with epilepsy taking ASMs can and should breastfeed if desired and able.
Later in life, another consideration for women who have epilepsy is many of the physiological changes during menopause. Many ASMs carry an increased risk of bone diseases such as osteopenia and osteoporosis for patients who are taking them12. Due to this, there is a higher risk of bone fractures especially during and after menopause. Epileptologists often will prescribe supplemental over the counter vitamin D to counteract the loss of bone density in patients on medications that may carry this risk. In many cases, they will also do extra tests to ensure bone density is strong and vitamin D levels are where they should be. In some cases, medication changes may be necessary.
If you are concerned about contraceptive options, childbirth, or menopause related to your anti-seizure medications, please speak with your doctor. The information, including text, graphics, images and other material on this website and provided by the Epilepsy Foundation of Northeastern New York, is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment.
If you are interested in learning more about seizure recognition and first aid, please reach out to our team by calling (518) 456-7501 or visiting our website for additional resources.
Citations:
- Velez-Ruiz, et al. Neurol Clin. 2016
- Herzog, et al. Neurology. 2009
- Meador, et al. N Engl J Med. 2009
- Teramo K, et al. J Perinat Med. 1979
- Vinten J, et al. Neurology
- Pack. Nat Clin Pract Neurol. 2006
- Tomson and Hiilesma. BMJ. 2007
- Harden, et al. Neurology. 2009
- Resinger, et al. Epil & Behav. 2013
- Meador, et al. JAMA Pediatrics. 2014
- Vieby, et al. JAMA Neurol. 2013
- Pack and Morrell. CNS Drugs. 2011
