Update on management of epilepsy in women for the non-neurologist

Abstract

Epilepsy is a common neurological disorder, prevalent in about 1% of the population. Almost half of the patients with epilepsy are women. Epilepsy and antiepileptic drugs can affect each aspect of the female human life cycle which includes menstrual cycle, contraception, fertility, conception, pregnancy and menopause. The interplay of the female hormonal state and epilepsy is complex and has to be taken in to consideration when managing their epilepsy. This review focuses on the management of women with epilepsy related to their role in reproduction.

Antiseizure drugs and women: Challenges with contraception and pregnancy

“…First, many antiseizure drugs decrease the effectiveness of hormonal birth control through enzyme induction (e.g., carbamazepine, phenytoin). [4][5][6]9 Estrogen is metabolized by the cytochrome P450 system, and enzyme inducers increase the first pass metabolism of estrogen, thereby contributing to subtherapeutic concentrations and contraceptive failure. For the second interaction, the estrogen in hormonal birth control can decrease the effectiveness of lamotrigine and valproate.…”

“…3,8 The simplest option for many women is to use either the copper intrauterine device (IUD) or the levonorgestrel IUD, as the efficacy of IUDs is not affected by drug interactions. [3][4][5][6] Women who take enzyme-inducing antiseizure drugs and hormonal contraceptives have 2 options-they can change their antiseizure drug or they can change their choice of contraceptive. The Provincial Guidelines for the Management of Epilepsy in Adults and Children are useful for identifying alternative antiseizure drug options based on epilepsy type, and pharmacists can help prescribers identify which options are less likely to interact with oral contraceptives.…”

“…3 Furthermore, antiseizure drug interactions can lead to contraceptive failure, which can result in an unplanned pregnancy. [3][4][5][6] During pregnancy, many antiseizure drugs increase the risk of teratogenicity 3,4,7 and can become less effective in controlling seizures. 3,4,8 We developed infographics to help pharmacists provide additional support to women who are taking antiseizure drugs, both for epilepsy and for other indications (Figures 1 and 2).…”

Gebelik Epilepsi Antiepileptik ilaçlar

“…Ayrıca epilepsi hastası kadınlarda gebelikte maternal ölüm oranının epilepsisi olmayanlardan 10 kat fazla olduğu bildirilmiştir. [9] Epilepsi hastalarında jinekolojik bir sorun olmadığı sürece normal vaginal doğum önerilmektedir. [10] II-Gebelikte epilepsinin seyri: Gebelikte nöbet sıklığı genellikle değişmemekle birlikte, nöbet sıklığında %14-32 arasın-Dr. Betül TEKİN da artış olabileceği bilinmektedir.…”

“…[12,19,20] IV-Konjenital malformasyonlar ve kognitif yan etkileri: Antiepileptik ilaçların teratojen yan etkilerine dikkat çeken pek çok çalışmada malformasyon oranı %4-9 olarak bildirilmiştir. [5,9,10,[13][14][15][16] Bizim çalışmamızda bu oran %6.8 olarak tespit edilmişti ve özellikle diş ve dismorfik özelliklerin valproat alanların çocuklarında daha sık görüldüğü bildirilmiştir. [21] Antiepileptik ilaçların özellikle de valproatın düşük IQ ve otistik spektrum hastalıklarına neden olduğu, karbamazepin, lamotrijin, levetirasetam ve fenitoinin kognitif gelişime etkisinin olmadığı yönünde bildiriler mevcuttur.…”