KOCHI: Epilepsy is a common neurological condition which is mainly influenced by hormonal changes and causes recurrent episodes of sensory disturbance and loss of consciousness. The condition, which affects women mostly, spans their entire adult life and requires specific management strategies.
For Women with Epilepsy (WWE), there’s a higher risk of complications during pregnancy. Research shows that two reproductive hormones in women estrogen and progesterone — can affect seizure control throughout their life. While estrogens lower the seizure threshold or increase the propensity of seizures, progesterones are seizure protective.
It is also observed that seizures in catamenial epilepsy (CE), also known as menstrual seizures, worsen during menstrual cycles. Women with CE would have more seizures during the phases of menstruation. It is advisable to meet a physician. Usually, doctors will advise the patient for intermittent therapy with medications perimenstrually or may ask to increase the dose of anti-seizure medications.
Reproductive health is also important in epilepsy management. Several anti-seizure medications can cause diminished sex steroid function. Commonly encountered problems include weight gain, menstrual cycle irregularities, mid-cycle spotting acne and increased facial hair.
Epilepsy and pregnancy
The chances of seizure recurrence are high during pregnancy. Seizures during pregnancy can also affect the foetus in several ways. Poor antenatal care and exposure to anti-seizure medications in the first trimester can increase the risk of major congenital malformations. The risk of malformation is pegged at 3% if the patient takes one anti-seizure medication, and up to 15% when two or more drugs are taken.
Increased risk of induction of labour, caesarean section and postpartum haemorrhage, anaemia, ovarian cyst, fibroid uterus, and spontaneous abortions are some other effects of epilepsy on pregnancy.
Also in the pre-pregnancy period, episodes of high seizures can occur, in such scenarios, more than two medications would be required.
What needs to be done?
Management of Women with Epilepsy is multifactorial. They should be counselled on reproductive issues, contraception, teratogenicity, pregnancy, labour, child-rearing and bone health. Before stopping the usage of contraceptive measures, it is essential to make necessary changes in epilepsy therapy. If patients who are diagnosed with epilepsy decide to get pregnant, it is ideal if they are seizure-free, and women with complex needs should be referred to specialist centres for detailed review and assessment.
During menopause
The incidence of epilepsy varies during perimenopause and menopausal periods. During the cycle, reduced ovarian secretion of progesterone or ovulatory menstrual cycles are observed. In some cases, bone health deteriorates, which results in an increased risk of fracture. Regular vitamin D supplementation and adequate dietary calcium are to be ensured during this period.
Mind & body
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The writer is a neurologist at Lourdes Hospitals, Kochi