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Epilepsy: A Different Disorder for Women
Romila Mushtaq, MD
Medical College of Wisconsin Epileptologist
Women with epilepsy face unique health challenges. Froedtert & the Medical College of Wisconsin’s Comprehensive Epilepsy Program is one of the few programs in the country with a multidisciplinary approach that ensures that women receive expert and coordinated care for their special needs.
Q. What is epilepsy?Epilepsy is a condition of the brain that makes people susceptible to seizures. A person who has had two or more unprovoked seizures is said to have epilepsy. A seizure occurs when nerve cells in the brain fire abnormal and synchronous electrical discharges. This causes an “electrical storm” or seizure in the brain.
By contrast, a person who has a provoked seizure does not have epilepsy. Examples of causes of provoked seizures are a high fever, alcohol or drug withdrawal and hypoglycemia (low blood sugar).
Epilepsy affects an estimated 2.7 million people in this country. It’s most common among young children and among adults over age 60. In children, the disease may be caused by congenital malformations of the brain, certain genetic syndromes or complications at birth. In older adults, it may be caused by stroke, hemorrhage, tumor or other vascular event. In up to 40 percent of cases, the cause is unknown.
Q. How does epilepsy affect women compared to men? Within the last 10 years, we’ve learned that there’s a dynamic relationship between seizures and hormones. The balance of estrogen and progesterone in the body greatly affects the frequency of seizures for women who have epilepsy.
Women with epilepsy face greater health challenges during puberty and the onset of menstruation, with infertility issues, irregular menstrual cycles, pregnancy complications, menopause and bone health.
Q. Why do some women experience more seizure during their menstrual cycle?There are changing levels of estrogen and progesterone during the menstrual cycle, and brain cells are sensitive to these changes. During ovulation and prior to a woman’s period, there are increased levels of estrogen compared to progesterone, and that imbalance can provoke seizures. About 60 percent of women with epilepsy experience increased seizure frequency around menstruation and ovulation.
Q. Is epilepsy treatment different for a woman than a man?Yes. We must consider a woman’s entire body when determining the appropriate antiepileptic medications. We’ve learned that some of the previous drugs on the market can cause malformations in a developing fetus, and contribute to irregular menstrual cycles, sexual dysfunction and higher infertility rates for women. Some women are not given the option to use the newer medications, which are safer to use during pregnancy and for a woman’s overall health.
In the last five to 10 years, new antiepileptic medications are available that don’t disrupt the delicate hormonal balance of a woman’s body. Some of these older medications have been linked to disrupting the neuroendocrine axis — the route of communication between the hypothalamus — the part of the brain that controls parts of the nervous system — and the pituitary and adrenal glands and ovaries, which secrete various hormones.
Medications can control the peaks in estrogen a woman experiences each month that can lead to seizures. A diuretic medication called diamox may be prescribed as well as oral contraceptives to control seizures that occur during the menstrual cycle. We refer women to gynecologists at Froedtert & the Medical College of Wisconsin for management to control or temporarily block the menstrual cycle to stop seizures that occur during the monthly cycle.
The earlier antiepileptic medications also increase the risk for calcium loss, leading to osteoporosis in women as well as in men. Therefore, we regularly perform bone density scans and refer women who have osteoporosis to Froedtert & the Medical College of Wisconsin physicians who specialize in treating this disease. We also transition women to the newer medications to lower their risk for osteoporosis.
Q. What are the misconceptions about women who have epilepsy?There are many misconceptions. One is that a woman should not become pregnant because the antiepileptic drugs she is taking can harm the fetus. The truth is that 95 percent to 98 percent of women taking antiepileptic medication can conceive and deliver a healthy baby with appropriate counseling and follow-up care with an obstetrician who specializes in high-risk pregnancies. Pre-pregnancy counseling provides a better chance that a woman will have a baby without any complications during pregnancy. We counsel women on the importance of taking folic acid and help them to prevent seizures that could occur during pregnancy.
Another false belief is that all pregnant woman taking antiepileptic medication will give birth to a baby with congenital malformations. With certain newer anti-epileptic medications, the risk is much lower. We can help women who are taking the earlier medications to transition to the new, safer drugs prior to becoming pregnant.
There’s also a belief that a woman cannot breastfeed if she is taking antiepileptic medication. The baby has already been exposed to the medications in the womb, and the amount of the drug in the woman’s breast milk is negligible. The benefits of breastfeeding outweigh the risk of exposure to this amount of medication.
Some women who are still having seizures incorrectly believe that they should stop taking their antiepileptic medication when they are pregnant. This actually is much more dangerous to both the woman and her unborn child. If a woman has a generalized seizure during pregnancy, it takes 20 minutes for the fetus’s heart rate and respiration to return to normal levels. A seizure also increases the risk of a miscarriage and placental abruption (early separation of the placenta from the wall of the uterus), which can cause life threatening problems for the mother and baby.
Q. Are there special considerations for women with epilepsy who are pregnant or planning to become pregnant?It’s important for our team to discuss pregnancy issues with women early on in order to anticipate their family planning needs, discuss any problems that could occur, and discuss the importance of continuing to take seizure medications if her seizures are not under control.
If a woman is not planning to become pregnant and she is taking birth control pills, she needs to know that taking the earlier antiepileptic medications can reduce the effectiveness of birth control bills by 40 percent to 75 percent. A woman may still become pregnant unless she uses additional forms of contraception.
For a woman who is pregnant or wishes to become pregnant, a concern is that antiepileptic medications can cause a deficiency in folic acid. This deficiency can lead to congenital malformations during pregnancy. I place all of my female patients of child bearing age on a folic acid supplement, even if they don’t anticipate becoming pregnant in the immediate future.
During pregnancy, antiepileptic medications metabolize more quickly, which could cause a woman to have a “break through” seizure. Because we want to avoid a seizure during pregnancy as much as possible, we follow the woman closely by doing blood tests to check her medication levels every four to six weeks.
Since women with epilepsy have a higher risk of complications during pregnancy, we coordinate her care with the Maternal Fetal Care Center at Froedtert & the Medical College of Wisconsin, which cares for women facing high-risk pregnancies.
Q. How is the care provided to women with epilepsy at Froedtert & the Medical College of Wisconsin different from other healthcare facilities?Froedtert & the Medical College of Wisconsin’s Comprehensive Epilepsy Program is one of the few programs in the country dedicated to addressing the unique challenges of women with epilepsy. The program’s multidisciplinary approach ensures that women with epilepsy receive coordinated care. In addition to me, all of our epileptologists — Humberto Battistini, MD and Manoj Raghavan, MD, director of the Comprehensive Epilepsy Program — have the expertise to meet the unique needs of women with epilepsy.
Our unique network of allied health professions offers support to women during the various cycles in their lives — from the onset of menstruation to menopause and beyond. Women can get a wealth of information in our program about how epilepsy will affect their life cycles — during puberty, their monthly cycle, pregnancy, menopause and beyond.
We do a thorough evaluation and offer extensive counseling, answer women’s questions and address any concerns. Our program also offers women opportunities to participate in a variety of clinical research trials. Many aspects of epilepsy in women are still understudied, and women can join the studies to help us gain knowledge to treat other women. Clinicians and researchers include epileptologists, obstetricians, gynecologists, endocrinologists, bone health specialists, psychiatrists and psychologists.
Source: Every Day Date: May - July 2006 | Medical Reviewer: | Romila Mushtaq, MD | | Medical College of Wisconsin Epileptologist |
Last Review Date: Aug. 9, 2011 Online Editor(s): Kathryn Adam |
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