There are some of the questions which many women with epilepsy ask
in relation to their own health and well-being. There are a growing
number of women who are recognising the importance of understanding
those aspects of health which only affect women, and doctors are beginning
to be asked more specific questions by women.
Monthly Periods
Some women do find that their seizures
seem to occur just before their monthly periods or during it. When
women only have their seizures only at this time , this is known
as “catamenial epilepsy”. The majority of women who do find that
their menstrual cycle affects their seizure pattern find that they
may have seizures at any time, but they are more common around the
time of menstruation. It is still not clear why this happens. It
may be due to changes in the hormones, oestrogen and progesterone,
which determine bodily changes throughout the menstrual cycle. It
may also be due to alterations in levels of body fluids at such
times.
Some women may benefit from taking additional
medication in the week preceeding their menstrual period and they
should discuss this option with their doctor.
Contraception
Because effective methods of contraception
are now available, having children has become a matter of choice.
Women with epilepsy may use all conventional methods of contraception,
the most popular of which is the contraceptive pill. There is no evidence
to suggest that taking the pill adversely affects epilepsy. However,
anti-epileptic medication can influence the metabolism of the pill
and reduce its effectiveness.
The low dose (30 micrograms oestrogen)
combined pill is as effective as usual if drugs that are not “enzyme
inducers” are being taken. Anti-epileptic drugs which are not enzyme-
inducers include : sodium valporate (Valparin), clobazam (Frisium),
gabapentin (Neurontin), ethosuximide (Zarontin) topiramate (Topamax)
and piracetam (Nootropil). Anti-epileptic drugs which are enzyme
inducers include : phenobarbitone, primidone (Mysoline), phenytoin
(Dilantin), and carbamazepine (Tegretol). Two drugs lamotrigine
(Lamictal) and oxcarbazepine (Trileptal) may be weak enzyme- inducers,
it is not yet fully certain whether they may affect the oral contraceptive
pill. If a woman is taking an enzyme-inducing drug and wishes to
rely on the oral contraceptive pill, she should start on a pill
containing 50 microgrammes of oestrogen. Any breakthrough bleeding
between periods is likely to be a sign that the dose of oestrogen
is not adequate. Should this occur, alternative precautions should
be used and the matter looked into. It is likely that the oestrogen
dose will need to be increased further. The increased risk of side-effects
from a higher dose of oestrogen does not apply in these circumstances
as the pill is being disposed of more quickly by the body. Even
with the precaution of taking a higher dose pill, the contraceptive
effectiveness is less certain than if enzyme-inducing drugs are
not taken. However, the effectiveness is comparable with barrier
methods.
Problems with low pills should not be
accepted as an indication that the pill in general is unsuitable
for women with epilepsy. There is no evidence to suggest that the
pill can influence epilepsy in any way, either beneficially or by
making the seizures worse. Other high- risk factors, e.g. age, obesity,
heavy smoking, etc. must be taken into account when considering
the suitability of the pill for a woman with epilepsy.
Planning Pregnancy
If a woman with epilepsy decides to have
a baby, what steps can be taken to avoid any problems which might
arise on account of the seizures? There are some special considerations,
but with appropriate guidance and information, most difficulties can
be overcome.
It is very important for women with epilepsy
to talk to the doctor responsible for their epilepsy treatment ideally
before conception or if not as early on in pregnancy as possible.
It is recommended that women taking anti-epileptic medication who
are planning on becoming pregnant should take a supplement of folic
acid (4 mg or 5 mg per day) starting before conception as it has
been shown that folic acid supplementation is able to reduce the
risk of neural tube defects.
[More information is available in the CIEN fact sheet “Pregnancy and
Childcare”]
Epilepsy and Inheritance
There are two main factors which determine
the development of epilepsy in an individual; first, the level of
that person’s seizure threshold and secondly the occurrence of an
injury to the brain. Everyone is capable of having a seizure if the
circumstances are appropriate and everyone has a certain “seizure
threshold” or “level of resistance” to seizures.
If the seizure threshold is very low,
that person may start having seizures spontaneously. If the threshold
is high, as in most people, some environmental trigger, for example
an injury to the brain, is required to initiate seizures. This threshold
is part of a person’s genetic make-up, and it is this threshold
which may be passed onto any children. There is, therefore, a genetic
element in the development of epilepsy in everyone, but the relative
importance of this is variable. Epilepsy may appear frequently in
some families, but in others only one member may be affected. Even
in these cases, genetics may well play a part, particularly if the
epilepsy cannot be attributed to any obvious injury.
The risk to a child born to a parent
with epilepsy will depend on the nature of the parent’s epilepsy,
and the level of the seizure threshold in both parents. Any child
born to a couple, one of whom has epilepsy, will run an increased
risk of having epilepsy, but this increase in risk is often small.
If both parents, however, have such low seizure thresholds that
they both have epilepsy, the increased risk to the child will be
greater.
It is also possible, although rare, for
a child to inherit a genetic condition from a parent, a symptom of
which is epilepsy. Examples of these include neurofibromatosis and
tuberous sclerosis.
The menopause
The average age of women when periods
stop and they can no longer become pregnant is the early fifties.
At this time, there may be hot flushes and rapid changes of mood.
Hormone Replacement Therapy (HRT) containing the sex hormone oestrogen
may be recommended to alleviate hot flushes and other menopausal
symptoms. While oestrogen may, theoretically, make seizures more
likely to occur, the small doses used in HRT do not usually cause
any problems. If, however, control of epilepsy does get worse when
HRT is taken, the possibility that it is responsible should be borne
in mind and consideration given to stopping it. Supplementary oestrogen
may also be prescribed to prevent excessive loss of calcium. This
process known as osteoporosis, causes thinning of the bones which
become increasingly brittle and liable to break more easily.
Epilepsy can develop at any stage of
life and some women may develop epilepsy at this time coincidentally.
Some women who have had seizures for many years may find that these
improve or disappear at this time. Some women may have noticed that
their seizures coincide with the pre-menstrual period and sometimes
with pregnancy and in these people, there may well be a link but
further research is needed in this area. Access to information and
good medical care are important so that women experience minimum
discomfort during menopause, and these services should be available
from the General Practitioner.
2004