Page 427 - ILAE_Lectures_2015

Chapter 44

Epilepsy and women

JOHN CRAIG and ELLEN CAMPBELL

Department of Neurology, Belfast Health and Social Care Trust, Belfast

Women, of all ages, with epilepsy have their own considerations which must be taken into
account if their care is to be optimised. Although the issues are usually considered when a
female becomes of childbearing age, antiepileptic drug (AED) therapy during childhood may
influence choices in adult life. From the time of diagnosis the important issues should
therefore be considered. The main areas to consider are:

 AEDs and appearance
 Female hormones and seizure control
 Fertility
 Contraception
 Pregnancy

– the effects of epilepsy and AEDs on pregnancy
– the effects of pregnancy on AEDs and seizure control
– the effects of epilepsy and, in particular, seizures on the developing

embryo/fetus
– the effects of AEDs on the developing fetus/embryo
– management of labour and postpartum management of mother and child
 Epilepsy and the menopause.

AEDs and appearance

Phenytoin therapy in childhood can lead to hirsutism, gingival hyperplasia and coarsening of
facial features. Sodium valproate can cause hair loss, acne and hirsutism. Sodium valproate
can also stimulate appetite leading to obesity, as can vigabatrin, gabapentin and pregabalin.
Conversely, topiramate can cause significant weight loss. While for some this may have a
beneficial impact, on occasions it can be extreme. The occurrence of these side effects, which
are mostly undesirable in all, can have a particularly detrimental effect during adolescence,
with all of its associated problems. For some their impact may be so great as to lead to poor
compliance with AEDs, resulting in loss of seizure control.

Female hormones and seizure control

Epilepsy and AEDs are associated with changes in female hormones that may result in
menstrual irregularity, reproductive problems, and abnormalities of bone health. Female
hormones may also affect seizure threshold, resulting in increased frequency of seizures at
certain times of the menstrual cycle.

Hormonal alterations, including changes in prolactin, follicle-stimulating hormone and
luteinising hormone have been observed following generalised and focal seizures.1 They are
thought to arise as a result of connections between the hypothalamic-pituitary axis and areas
of the brain involved in seizures, although the precise mechanisms are unclear1-3. These