Women with Epilepsy: A Different Perspective
Marianna Spanaki-Varelas, MD, PhD
Medical College of Wisconsin Neurologist
“There is a great need to increase physicians’ knowledge and understanding of issues related to women with epilepsy.”
Approximately 1.1 million women of childbearing age in the U.S. have epilepsy. What does living with epilepsy mean for these women? Marianna Spanaki-Varelas, MD, PhD, talks about a few of the many, many issues epileptic women confront on a regular basis.
Q: When you think about it there are really a multitude of issues that affect a woman with epilepsy. What is at the core of these issues?Women with epilepsy represent a distinct patient population, mainly due to the effect of female hormones — estrogen and progesterone — on seizure activity and vice versa. Estrogen which is high during the first half of a woman’s menstrual cycle may increase seizure frequency; and progesterone, which increases in the second half of the cycle, may reduce seizures. Further, epilepsy itself may affect these hormone levels and that can result in problems with menstrual cycles and fertility.
This state of hormonal imbalance has a branching out effect, having influence over a variety of issues in a woman’s life — from reproduction to menopause. For example, a large group of epileptic women experience increased seizures right before their period, a pattern called catamenial epilepsy. Some medications for epilepsy interfere with birth control pills, making them less effective, resulting in unplanned pregnancy. Some menopausal women take hormone replacement therapy that can effect seizure patterns. So, hormonal activity plays a major role in a woman’s experience with epilepsy.
Q: Pregnancy would seem to be one of the biggest challenges facing women with epilepsy. How is this approached? Women with well-controlled epilepsy should not be discouraged from having children. With careful pregnancy planning, comprehensive and coordinated care, close monitoring of seizures and drug levels, and early tests for birth defects, women with epilepsy should be able to have healthy babies.
There are many myths surrounding pregnancy and anti-seizure medications — the most prevalent being that these medications should not be taken during pregnancy. It’s very important for a pregnant woman to continue with her anti-seizure medication during pregnancy because any seizures experienced could result in miscarriage or birth defects. Again, medication levels must be monitored during pregnancy, and only the minimum effective dose should be taken. It’s also very important for women with epilepsy to plan their pregnancy. Planning far enough in advance gives us great opportunities to prevent birth defects by adding folic acid to their diet, coordinating their care by having their neurologist, OB/GYN and the rest of their health care team work together and prepare the labor team so everything goes smoothly.
Q: Let’s talk about the other big issue for women with epilepsy: menopause. As I mentioned earlier, menopausal women with epilepsy who take hormone replacement therapy will experience further hormonal imbalance and their effects. This is an area that needs further study. In addition, osteoporosis, which is generally thought of as a risk for women in menopause, can be a threat to women with epilepsy of all ages if they take certain anti-seizure medications. Again, more research is needed here, but it’s also important for these women to get the needed calcium, vitamin D, regular exercise, and in some cases, bone scan screenings for osteoporosis.
Q: What’s the biggest need you see right now in providing women with epilepsy with the care they need?There is a great need to increase physicians’ knowledge and understanding of issues related to women with epilepsy. Studies have been done that show that there is a real deficiency in physician knowledge of this area. Once this understanding is increased we can coordinate care for women across the healthcare spectrum so that an entire team is working together — epileptologists (neurologists specializing in epilepsy), OB/GYNs, endocrinologists, psychologists, psychiatrists, nurses and social workers.
Women on the whole are great patients — they ask questions, learn all they can and generally take an active role in their care. This gives us, as health professionals, a great opportunity to provide them with the level of care they deserve.
Source: Every Day
Date: January-April 2003