Understanding Epilepsy in Women: The Challenges and Triumphs of WWE
Dr Soniya Tambe, MD, DM (Neurology), Consultant Neurologist and Epileptologist, Kauvery Hospitals, Bengaluru explains all women need to know about epilepsy
Epilepsy is a disorder of brain causing recurrent “seizures” or “fits”. Symptoms of seizures depend on specific area of brain. Symptoms can be jerking of limbs, staring episodes, sudden falls, confusion, transient loss of consciousness, strange emotional feeling, anxiety, psychosis and many more. Though epilepsy can affect people with any age, gender; epilepsy in women raises special concerns, which are discussed in this article.
Epilepsy and hormonal/menstrual cycles:
Most important hormones in women are oestrogen and progesterone. Oestrogen in pro-convulsant (increases seizure risk), progesterone is anti-convulsant (decreases seizure risk). There are times in woman’s life when changes in hormone levels and hormone balance happen: during puberty, periods, pregnancy and throughout menopause, thereby increasing seizure risk during these situations. Some women have seizures during specific time around their menstrual cycle, specially just before menses, which is called “catamenial epilepsy” ( katamenios is Latin for menses).
Contraception (birth control) for women with epilepsy:
In most cases, anti-seizure drugs can make hormonal birth control less effective, but in some cases hormonal birth control can make antiseizure drugs less effective. Using either barrier methods(condom/diaphragm) for contraception or having intra uterine device is most suitable for women with epilepsy.
Epilepsy in women and fertility:
According to many studies women with epilepsy have fewer children. Possible explanations are fear of having child with birth defect, sexual dysfunction, anovulatory cycles (Cycles where no egg is released from ovary), Polycystic Ovary Syndrome. However according to recent study in 2018, women without prior diagnosis of infertility or related disorder, women with epilepsy experienced similar pregnancy rates compared with their peers without epilepsy. Close follow up with healthcare provider is recommended.
Epilepsy and pregnancy:
Most women with epilepsy have uneventful pregnancy period, however some women especially uncontrolled seizures can have worsening of seizures requiring frequent follow up, drug level monitoring. Research has shown that some medications increase the risk of birth defects in unborn child. These are: Valproic acid, Carbamazepine, Phenobarbital, Phenytoin, Topiramate. Most common birth defects are Spine problems- spina bifida, cleft lip, heart abnormalities. Also, higher chance of child having delayed speech, language and problems with memory attention. Folic acid supplement starting before pregnancy and carefully choosing antiseizure medications during pregnancy is recommended. Also, women with epilepsy may need extra appointments, blood tests, scans to check baby’s development.
Breast feeding and seizure medications:
Breastfeeding a new born has many advantages, including improving baby’s health, bonding and is integral part of experience of motherhood. For most antiseizure medications, level of drug in breast milk is very less and it is safe to breastfeed baby. Close monitoring of baby for level of alertness, sleepiness, not gaining weight or developmental issues is needed. Certain tips may lessen amount of medicine that reaches baby- preferably taking medicine once a day during beginning of baby’s longest nap, breast feeding the baby immediately before taking medicine.
Women with epilepsy and social stigma:
Women with epilepsy are more vulnerable to the psychosocial burdens of epilepsy. They experience difficulty with education, employment, mobility, low self-esteem, low social interactions and relationships. There are many examples where is women with epilepsy are subjected to ridicule, neglect and abandonment by families. Healthcare providers, social works, policy makers need to have deep understanding of social and cultural perceptions of epilepsy and need to work towards betterment of quality of life in women with epilepsy.
