Women and Epilepsy
Epilepsy has several implications in women’s health. The Mount Sinai Hospital has experts specially trained to work with these issues, some of which are described below.
Epilepsy and Menstruation
Hormones can affect epilepsy, and a significant number of women may experience worsened seizures during or just before their periods. Catamenial epilepsy refers to epilepsy affected by the menstrual cycle. Sometimes, increased doses of antiepileptic medication can be tried during vulnerable times of the month, but there are no FDA-approved guidelines yet. The Epilepsy Center at The Mount Sinai Hospital individually tailors each treatment plan depending on the patient’s pattern of seizures.
Epilepsy and Oral Contraceptives
Many antiepileptic drugs interact with oral contraceptives making them less effective. This is particularly true of carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone, and topiramate. To be safe, women are advised to use a barrier method of birth control as back-up to prevent unwanted pregnancy.
Epilepsy and Pregnancy
Women with epilepsy wishing to start a family are advised to talk to their doctors. While many antiepileptic drugs may slightly increase the risk of birth defects, the vast majority of women with epilepsy have healthy babies. Newer studies are redefining which drugs are safer; lamotrigine and carbamazepine are relatively safe. In contrast, valproic acid has a higher incidence of major birth defects compared with other antiepileptic medications. Whenever possible, using only one antiepileptic medication is recommended in pregnant women or those planning to become so. That’s why women with epilepsy considering pregnancy should talk to their neurologists before conception so that adjustments can be made to their regimens. Any woman of childbearing age taking antiepileptic medication should receive folic acid supplementation to help prevent birth defects.
Despite the risk of birth defects, stopping antiepileptic medication is never a good idea without first speaking to a neurologist. Seizures can be harmful to both mother and fetus.
Epilepsy and Breastfeeding
The American Academy of Neurology recommends breastfeeding for women with epilepsy. There are some conceivable risks of breastfeeding to infants whose mothers are taking antiepileptic medication. The newer generation of antiepileptic medication is actually thought to carry a greater risk of transmission through breast milk. Despite the possible risks, the proven benefits of breastfeeding, such as reduced risk of autoimmune disorders, and enhanced cognitive abilities, are compelling.
The Mount Sinai Epilepsy Center
1468 Madison Avenue
Annenberg 2nd floor
New York, New York 10029