Our expert is Jacqueline French, Professor of Neurology, NYU Comprehensive Epilepsy Center, New York University Langone Medical Center.

If there is a medical topic you would like to see explored here, please let me know!

Very best,

Mitzi Perdue

MPerdue@LiebertPub.com

EPILEPSY IS SURPRISINGLY COMMON

Epilepsy is not just one condition, but rather a group of many different “epilepsies.” What they all have in common is that the brains of affected individuals are capable of having spontaneous seizures. One out of every 26 people on earth has epilepsy, and it’s more common than all the following conditions combined: Parkinson’s Disease, cerebral palsy, autism, and multiple sclerosis. Most people don’t realize how common epilepsy is because there’s enormous stigma attached to the condition and people who have it are likely to try to hide it.

THE PERFECT DRUG FOR WOMEN WITH EPILEPSY DOES NOT YET EXIST

Equal numbers of men and women have epilepsy. However, even though in the last 25 years we’ve tripled the number of medications for treating epilepsy, and even though many of these medications are highly effective in preventing seizures, it remains true that the number of medications appropriate for women of childbearing age are small.  Anti-seizure medications can interfere with the effectiveness of a woman’s birth control pill, may cause birth defects, and blood levels for some of the medications may change as her own hormones fluctuate. 



TREATMENT FOR EPILEPSY INVOLVES MANY POSSIBLE CHOICES

Currently treatment for epilepsy is an art as well as a science. We have many drugs to choose from, and the choices are influenced by many factors. These include: the type of epilepsy she has; her age; whether she’s planning to become pregnant; and any underlying medical conditions. As an example of factors influencing the choice of medications, a drug that may be ideal for her if she’s not planning to become pregnant can be a disastrous choice if she is planning pregnancy.

BOTH GYNECOLOGISTS AND NEUROLOGISTS NEED TO BE INVOLVED IN THE CARE OF WOMEN OF CHILDBEARING AGE

When a woman with seizure disorder becomes sexually active, it’s critically important that her gynecologist and her neurologist together get involved in her care. Unfortunately, too often this doesn't happen. After all, a typical woman doesn’t call her neurologist and say, “Hey, I just started the pill and want to see you!” Even so, both specialists need to be involved because some of the best medications we have for seizure disorder result in decreased effectiveness of hormonal birth control. This happens because some of the anti-seizure drugs, such as the liver enzyme-inducing drugs, increase the rate at which the liver breaks down the contraceptive hormones. The result is, her contraception medication will leave her body much faster than otherwise would be the case and she’s at greatly increased risk for unintended pregnancy. It’s important to get the birth control medications right because the rate for unintended pregnancy for women with seizure disorder may be as high as 65%. Further, hormonal birth control medications may decrease the effectiveness of some anti-seizure medications. If her neurologist and gynecologist aren’t working together to monitor her medications, it can be as if she’s on half the dose of the medications that she was prescribed. Her risk for seizures would then be increased. 

UNINTENDED PREGNANCY IS PARTICULARLY PROBLEMATIC FOR WOMEN WITH EPILEPSY

Unintended pregnancy for a woman with epilepsy is a serious issue: when a pregnancy is unplanned, there isn’t time to adjust her medications. Her anti-seizure medications may increase her baby’s risks for autism or being a special needs child or other birth defects. In view of these risks, it’s important to avoid unintended pregnancy. Ideally, a woman with epilepsy will plan her pregnancy, working in concert with her obstetrician and neurologist, giving them time to adjust her medications and the dosages. Her anti-seizure medications will need to be monitored regularly throughout her pregnancy.