Women With Epilepsy

Birth Control: Before deciding to use oral contraceptives, women who take anticonvulsant medication should consult with their physician. The effectiveness of birth control pills may be impaired when women take certain types of anticonvulsants. Breakthrough bleeding can occur and the effectiveness of oral contraceptives can be lessened. However, not all anticonvulsants interact negatively with birth control pills. Your physician may recommend an oral contraceptive with a lower estrogen content, or suggest alternative birth control methods.

Seizures During Pregnancy: Approximately 50% of all women with epilepsy have increased seizure frequency during pregnancy. Slightly less than half have no particular change in seizure frequency and a small percentage have reduced numbers of seizures during pregnancy. Reasons for these shifts in seizure frequency include dramatic swings in the hormone levels during pregnancy, changes in body fluid and salt retention, and alterations in the way the body absorbs, distributes and eliminates anticonvulsant drugs. Changes in metabolism usually return to nomal around three months after delivery.

It is vitally important for women to see their physician regularly during pregnancy and 3-4 months postpartum so that anticonvulsant drug levels can be carefully monitored and adjusted as necessary. More frequent blood level measurements are necessary dure to the mother's extra body weight and fluid retention during pregnancy.

Women are naturally concerned about the effect of seizures on the fetus. Most available information indicates that the number of seizures during pregnancy has little effect on the baby, except in the rare case of uncontrolled multiple seizures, known as "status epilepticus". This is a life-threatening condition to the mother and the baby and is considered a medical emergency.

Possible Complications During Pregnancy: Women with epilepsy are considered to have "high risk" pregnancies. High risk indicates that there is an increased likelihood of greater-than-average risks to the mother or fetus or both. There are several compilations which occur more often to women with epilepsy, one of which is known as "eclampsia".

Eclampsia is a serious complication of pregnancy which, in its final stages, can result in brain hemorrhage, coma and death. "Pre-eclampsia" is an earlier stage of this vascular disease. Weight gain and salt retention can lead to the development of pre-eclampsia, and a physician will carefully monitor a woman's blood pressure and check for protein in her urine - two indicators of the condition. Initial symptoms can include headache, hyperirritability, and edema(swelling) of the body and face. At the first sign of pre-eclampsia a physician will prescribe preventative measures, including sedation, rest and the use of specific antihypertensive drugs.

Placental problems figure more prominently in women with epilepsy. Premature separation of the placenta (abruptio placetae) may occur, and the accompanying vaginal hemorrhage may severely inhibit the nutrition of the developing fetus. Other complications involving the placenta include early spontaneous rupture of the membranes, and conversely, an increased need to rupture the membranes artificially in order to begin delivery.

Drugs & the Developing Fetus: Since all drugs present a possible danger to a developing fetus, women with epilepsy, who are taking anticonvulsants are understandably concerned that anticonvulsant medication may pose possible risks to their baby's development.

In pregnant women who had epilepsy as children, but have now outgrown it, and are not currently taking anticonvulsants, 4 in every 100 will have a baby with a birth defect.

Pregnant women who are controlling their seizures with anticonvulsants, will have 6 to 10 chances in 100 of giving birth to a baby with a birth defect. These figure indicate that women with epilepsy have at least a 90% chance of producing a perfectly nomal baby.

Epilepsy and The Menstrual Cycle: There is a type of epilepsy that is specific to women and may even affect the majority of women with epilepsy. Called catamenial epilepsy, it refers to changes in the frequency of seizures following fluctuations in hormone levels throughout the menstrual cycle.

Seizure frequency can vary in different phase of the menstrual cycle for several reasons. In some cases the reasons are not known or there may be no relationship at all. In other cases, the relationship is based on estrogen's excitatory effect and/or progesterone's inhibitory effect on the brain. As the levels of these and other sex hormones vary, the likelihood of having seizures changes.

Epilepsy & Menopause: There have been various findings on the effect of menopause on epilepsy. Studies indicate that seizure frequency often decreases, especially if seizures had been related to menstruation. Findings also suggest that epilepsy improves during menopause if epilepsy started later in life, and if seizures have always been infrequent. Sometimes seizures may completely disappear.

Some increases in the number of seizures have been found in women who have frequent tonic-clonic or complex partial seizures. During menopause, fluid retention, may also increase seizure frequency. Occasionally, for unknown reasons, epilepsy may occur for the first time at menopause.

Studies indicate that women who experience complex partial seizures have a higher rate of premature menopause than those who have other types of seizure.

To date, there is little data on which to evaluate the impact of hysterectomy, a surgically induced menopause, on the frequency of seizures.