Women with Epilepsy

Women with Epilepsy

Women with epilepsy face unique challenges due to the effects of seizures and anti-seizure medications on hormonal function, potentially affecting both sexual and reproductive health.  In the past, it was felt that it was inappropriate for women with epilepsy to have children. This idea was based on the misconceptions that epilepsy is always inherited and that it is unsuitable for women with epilepsy to raise children because of the risk of recurrent seizures. Unfortunately, this stigma towards women with epilepsy is still present and it affects their well-being.

The Women’s Epilepsy Clinic at Beaumont Hospital addresses the specific needs and concerns of women with epilepsy. This program was created to provide women with epilepsy with neurological clinical care as well as psychological support and counseling. The clinic team collaborates with primary care, obstetrics and gynecology as needed in providing an individualized treatment plan to address the following different phases of a woman’s life and how epilepsy relates to them. 

Adolescence

Adolescence is a time to establish self-identity and during which one is trying to build independence. Epilepsy can make getting to that point more difficult. Often, women with epilepsy feel that their peers cannot relate to the challenges they face, and they isolate themselves. In addition, parents can often become overprotective and this can lead to rebellious behavior and lead to medication non-compliance. It is the parent’s duty to discuss with their daughters the appropriate level of independence based on the severity of the seizures.

Sexuality

Women with epilepsy have a higher incidence of sexual dysfunction manifested by decreased sexual desire and potency. This is secondary to seizure medications interaction with endogenous hormone. This, in combination with living with the perceived stigma and the adverse influences of depressed mood and poor self-esteem, create a multifactorial etiology for sexual dysfunction. 

If you are sexually active and are on oral contraceptives, it is important to know that there can be an interaction between oral contraceptives and many anti-seizure medications. Some medications, such as carbamazepine (Tegretol), can induce the metabolism of estrogen and progesterone which consequently reduces the effectiveness of oral contraceptives. In the Women’s Epilepsy Clinic, we provide counseling as well as strategies to circumvent this issue. 

Menstruation

Two hormones (estrogen and progesterone) fluctuate throughout the course of the menstrual cycle which can lead to a change in seizure frequency.

Catamenial epilepsy is the clustering of seizures in alignment with the female reproductive cycle. Two predominant patterns of catamenial seizures are seen, perimenstrual and periovulatory, with the perimenstrual pattern being more common. 

Seizure frequency is linked to the ratio of serum estradiol to progesterone with higher ratios leading to clustering. This ratio is highest during the premenstrual period (secondary to the rapid withdrawal of progesterone) and the days preceding ovulation (secondary to the rapid, steep increase in serum estradiol. 

There are various treatments for the treatment of catamenial seizures and we can discuss different strategies in detail during your visit. 

Pregnancy

Approximately one-half million women with epilepsy are of childbearing age in the US and 3 out of 5 births per 1000 will be to women with epilepsy. Treatment during pregnancy is a balancing act between the teratogenic risk of anti-seizure medications and maintaining maternal seizure control. Overall the risk of teratogenicity from anti-seizure medications is low and the risk of harm to the fetus is higher with a convulsive seizure. Therefore, maintaining seizure control during pregnancy is of utmost importance and it is discouraged to discontinue medications during that time. 

Through our Women’s Epilepsy Clinic, we provide ongoing monitoring during pregnancy, delivery and postpartum period. In addition, we provide counseling on all pregnancy and delivery related concerns including adequate supplementation with folic acid to prevent neural tube defects to matters surrounding delivery and breastfeeding.  

Perimenopause and Menopause

A study evaluating the effect of menopause and perimenopause on the course of epilepsy found that two thirds of women reported an increase in seizure frequency, with women having a history of catamenial epilepsy more likely to have increased seizures. This is thought to be due to the elevation of the estrogen/progesterone ratio during this period. In addition, hot flashes, hormone replacement therapy and perimenopausal sleep disruptions may all influence seizure patterns. If you are going through these changes, we can help you find the right medication regimen to reduce seizures.

Women’s Epilepsy Clinic

Our clinic is staffed by a highly trained and specialized multidisciplinary team. The clinic program staff includes a board-certified, fellowship trained neurologist, certified EEG technologists, an epilepsy nurse practitioner and an epilepsy program nurse coordinator. The team works together with interdisciplinary experts in neuropsychology, neurosurgery and radiology to offer the following programs:

• pharmacologic management
• drug resistant epilepsy
  
• vagus nerve stimulator treatment
  
• surgical treatment options 
  
• collaborative, ongoing communication with primary care, obstetrics and gynecology 
  

As part of Beaumont’s level 4 comprehensive epilepsy center, Women’s Epilepsy Clinic patients have access to the most advanced EEG and imaging technologies available, including MEG (magnetoencephalography), a non-invasive diagnostic tool that safely explores the brain’s inner regions.