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Epilepsy and Women

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Effect of Epilepsy on Women
Women diagnosed with epilepsy face unique health issues that include reproductive problems, osteoporosis, excessive weight gain, and sexual dysfunction.
  • Fertility rates for women with epilepsy are about a third lower than the general population. Although this may be partly due to the fact that women with seizure disorders may be reluctant to have children, research shows that these women face more menstrual abnormalities, polycystic ovarian syndrome (PCOS), and other reproductive problems which can interfere with normal fertility. The causes of these reproductive problems have been linked to seizures and the side effects of certain anti–epileptic drugs (AEDs).
  • According to Dr. Cecilie M. Lander of Epilepsy Queensland, the drugs of first and second choice for most women with primary generalized epilepsy are valproate and lamotrigine in whatever dose controls the epilepsy. She also advises that women who may unexpectedly become pregnant should take the “Reasonable insurance” of 1 mg of folic acid daily.
  • AEDs that can interfere with the effectiveness of birth control pills include Dilantin (phenytoin), Tegretol (carbamazephine), and barbiturates such as phenobarb, prominal, mysoline, and topamax (topiramate).
Pregnancy and Women
The effect of pregnancy on frequency and intensity of seizures varies widely with women with epilepsy. Some have a decrease in seizures, about 25% face an increase in events, but in most there is no change at all. If a woman has been seizure–free for two to three years, she might be able to withdraw from drug therapy.

Women with epilepsy who want to become pregnant should discuss with their doctor the possibility of discontinuing medication at least six months before trying to conceive. Women who need to continue medication should be on the lowest possible dose of a single type of drug, if feasible. There is no proof that monotherapy with any of the standard drugs is any better than any other, but some physicians believe carbamazepine is the safest agent. Women with untreated epilepsy and those taking a single drug have a slightly increased risk (3% to 6% compared to 2% in the general population) of bearing children with birth defects. The risk increases, however, to 5% with two drugs and 10% with three.

All standard anti–seizure drugs increase the risk for birth defects. Studies on the effects of the newer add on drugs are still in progress, although animal studies are encouraging. Carbamazepine and valproate have been linked specifically to neural tube defects, which are generally caused by low folic acid levels. Folic acid is recommended for all pregnant women, in any case, and some experts recommend that those with epilepsy who are taking these drugs take a 5 mg. supplement of folic acid.

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