Epilepsy and women s health
This presentation is the property of its rightful owner.
Sponsored Links
1 / 47

Epilepsy and Women’s health PowerPoint PPT Presentation


  • 48 Views
  • Uploaded on
  • Presentation posted in: General

Epilepsy and Women’s health. Olgica Laban-Grant , MD Northeast Regional Epilepsy Group NEREG 2011. Epilepsy in Women. Role of hormones in epilepsy Contraception and AED’s Pregnancy and epilepsy Postpartum period and epilepsy Bone health and epilepsy Epilepsy in adolescence

Download Presentation

Epilepsy and Women’s health

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Epilepsy and women s health

Epilepsy and Women’s health

OlgicaLaban-Grant, MD

Northeast Regional Epilepsy Group

NEREG 2011


Epilepsy in women

Epilepsy in Women

  • Role of hormones in epilepsy

  • Contraception and AED’s

  • Pregnancy and epilepsy

  • Postpartum period and epilepsy

  • Bone health and epilepsy

  • Epilepsy in adolescence

  • Epilepsy in menopause


Epilepsy in women hormones and seizures

Epilepsy in WomenHormones and Seizures

Female hormones change the excitability of the brain and alter the threshold for seizures

Estrogen –decreases threshold

Porgesteron- increases threshold


Hormon sensitive seizures catamenial epilepsy

Hormon sensitive seizuresCatamenial epilepsy

In 1/3 of female patients there is substantial relationship between seizures and menstrual cycle.


Catamenial epilepsy

Catamenial Epilepsy

Seizures that tend to cluster in relationship to menstrual periods

  • High levels of estrogen

  • Low levels of progesterone

  • Fluid and electrolyte imbalance

  • Psychological Stress

  • Decrease in levels of AEDs


Epilepsy in women catamenial epilepsy

Epilepsy in Women Catamenial Epilepsy


Catamenial epilepsy1

Catamenial epilepsy

Pattern 1 – just before menstruation (steep decline in progesterone)

Pattern 2 – just before ovulation ~day 14 (steep elevation in estrogen)


Catamenial epilepsy2

Catamenial epilepsy

  • Pattern 3- in second half of menstrual cycle

  • Anovulatory cycles (ovulation does not occur) are more frequent in women with epilepsy

  • There is no elevation of progesterone


Catamenial epilepsy3

Catamenial epilepsy

What should you do:

Keep diary of your seizures and menstrual periods

Discuss with your neurologist possibility of catamenial epilepsy


Management of catamenial seizures

Management of Catamenial Seizures

  • Your doctor may treat you with

  • Increase in doses of antiseizure medications during particular time of menstrual cycle

  • Supplementation with reproductive hormones-natural progesterone


Management of catamenial epilepsy

Management of catamenial epilepsy

  • Cyclic

    • Natural progesterone seems to work better

  • Suppressive

    • Depo-provera


Birth control and epilepsy

Birth control and epilepsy

Some of the antiseizure medication decrease efficacy of birth control pills and other hormonal birth control

This may result in birth control failure and unplanned pregnancy


Birth control pills and epilepsy

Birth control pills and epilepsy

  • Antiseizure medications that interfere with birth control are:

  • Carbamazepine (Tegretol)

  • Phenobarbital

  • Phenytoin (Dilantin)

  • Primidone

  • Rufinamide (Banzel)

  • Topiramate (Topamax) *higher doses

  • Oxcarbazepine (Trileptal) *higher doses


Contraception

Contraception

  • AED’s that have no influence on levels of steroids

    • Gabapentin (Neurontin)

    • Lamotrigine (Lamictal)

    • Levetiracetam (Keppra)

    • Tiagabine (Gabatril)

    • Zonisamide (Zonegran)

    • Pregabalin (Lyrica)


Lamictal

Lamictal

Does not lower efficacy of oral birth control pills, but oral birth control pill can decrease levels of Lamictal


Contraception1

Contraception

  • Solutions:

  • Using antiseizure medications that do not interact with birth control pills

  • Using alternative birth control methods

  • Using birth control pills with higher dose of estrogen


Contraception2

Contraception

  • OCP with higher doses of estrogen (50 micrograms)

  • Depo-Provera - more frequent (6-8 weeks)

  • If breakthrough bleeding

    • Increase dose of estrogen

    • add barrier method

      • Condoms

      • Cervical diaphragm or cervical cap

      • Spermacides


Fertility and epilepsy

Fertility and Epilepsy

Women with epilepsy have fewer children

  • Possible explanations:

  • Choice (fear of having child with birth defect)

  • Sexual dysfunction

  • Women with epilepsy have more frequent anovulatory cycles (cycles where there is no egg released from ovary)

  • Polycystic Ovary Syndrome (PCOS)


Polycystic ovary syndrome pcos and epilepsy

Polycystic Ovary Syndrome (PCOS) and epilepsy

  • Definition of syndrome– two out of three of following:

  • Multiple cysts in ovaries

  • High male hormone levels

  • Excessive facial hair and acne

    • Other features

  • Obesity

  • Irregular menstrual periods

  • More frequent anovulatory cycles


Polycystic ovary syndrome pcos and epilepsy1

Polycystic Ovary Syndrome (PCOS) and epilepsy

  • Syndrome is twice as common in women with epilepsy

    Possible explanations:

  • Seizure activity in brain alters the production of hormones

  • Valproic acid (depakote) causes features similar to PCOS


Epilepsy and pregnancy

Epilepsy and Pregnancy

Over 90% of babies born to women with epilepsy will be healthy.

This number may be higher if pregnancies are planned.

Although low, birth defect rate is still about twice (4-7%) of rate in general population (1.6-3.2%).


Epilepsy in women pregnancy

Epilepsy in Women Pregnancy

Higher risk is due to:

Seizures

Antiseizure medications

Genetic


Epilepsy in women pregnancy1

Epilepsy in Women Pregnancy

  • Plan pregnancy!

  • May need to change AED drug/dosage

  • Folic Acid: start before pregnant

  • Close supervision with neurologist

  • High-risk pregnancy OB is preferred


Seizures in pregnancy

Seizures in Pregnancy

What can you do about seizures:

Women who have better control of seizures prior to pregnancy usually have fewer seizures during pregnancy.


Aed s in pregnancy

AED’s in pregnancy

  • More birth defects with:

    • Polypharmacy (two or more AED’s)

    • Higher levels of medications


Aed s in pregnancy1

AED’s in pregnancy

What can you do about antiseizure medications:

Your neurologist/epileptologist will consider:

Reducing your medications to single medication (monotherapy)

Changing your medication

Decreasing dose of your medication

Stopping your medication


Epilepsy pregnancy aed national pregnancy registry

Epilepsy & PregnancyAED National Pregnancy Registry

  • Tracks use of AEDs and pregnancy outcomes

  • All information confidential

  • Can greatly improve our knowledge


Epilepsy in women pregnancy registry resources

Epilepsy in WomenPregnancy Registry Resources

North American Pregnancy Registry

888 – 233 - 2334


Epilepsy and pregnancy fetal risks

Epilepsy and PregnancyFetal Risks

  • Most common major malformations:

    • Neural tube defects

    • Heart abnormalities

    • Orofacial clefts


Folic acid

Folic acid

  • Folic deficiency is associated with increase risk of neural tube defects.

  • Aed’s that are linked to folic acid malabsorbtion/metabolism are

    • Phentoin (Dilantin)

    • Carbamazepine (Tegretol)

    • Barbiturates

    • Valproate (Depakote)


Prenatal care

Prenatal care

Take extra folic acid (1-4mg per day) while trying to conceive

Take prenatal vitamins while trying to conceive.

Discuss possibility of genetic counseling, especially if there is history of birth defects in family.


Epilepsy in women prenatal testing

Epilepsy in Women Prenatal Testing

  • Testing that may be done to detect some of birth defects:

  • Maternal serum alpha-fetoprotein at 15-22 weeks of gestation

  • Level II ultrasound (structural) at 16-20 weeks of gestation

  • Amniocentesis at 15-20 weeks of pregnancy


Epilepsy in women pregnancy2

Epilepsy in womenPregnancy


Epilepsy in women postpartum issues

Epilepsy in WomenPostpartum issues

  • AED levels may rise – close monitoring of levels is necessary

  • Sleep deprivation and stress may increase frequency of seizures

  • Child safety/lifestyle adaptation


Epilepsy in women breastfeeding

Epilepsy in WomenBreastfeeding

Benefits of breastfeeding are felt to outweigh potential risk of continued exposure of neonate and infant to AEDs (AAN and AAP)

  • Protein bound drugs have low concentrations in breast milk

  • Observe breastfeeding infant for irritability, poor sleep patterns, or inadequate weight gain


Epilepsy in adolescence

Epilepsy in adolescence

  • Most seizure disorders are not altered by onset of puberty

  • Certain types of epilepsy start at approximate age (JME) or improve (benign rolandic epilepsy, absence epilepsy)

  • Rapid growth may account for poor seizure control


Epilepsy in adolescence1

Epilepsy in adolescence

  • Menarche (first period)

    • Discuss hormon sensitive seizures

    • Interactions of AED’s with contraceptive pills

    • Start folic acid supplementation

    • Discuss planning of pregnancy


Epilepsy in adolescence2

Epilepsy in adolescence

  • Discuss

    • Choice of medications

    • Substance abuse

    • Sleep deprivation

    • Compliance to medications

    • Driving

    • Sports safety

    • Choice of profession


Epilepsy and menopause

Epilepsy and menopause

  • Premature menopause is more common in WWE

  • Effect on seizure frequency is unclear as both estrogen and progesterone levels drop

  • Catamenial epilepsy seems to improve


Epilepsy and menopause1

Epilepsy and menopause

  • Doses of AED’s may need to be changed due to changes in metabolism

  • Polypharmacy due to other medical conditions may affect efficacy of AED’s and seizure

  • Hormone replacement therapy

  • Bone health


Epilepsy hrt

Epilepsy & HRT

  • HRT increases estrogen levels and may increase seizure frequency – concomitant use of natural progesterone may help

  • AED’s may affect HRT efficacy


Epilepsy bone health

Epilepsy & Bone health

  • Fractures are more likely in people with epilepsy due to:

    • Falls due to seizures and due to side effects of AED’s, and

    • Altered bone density due to certain AED’s


Epilepsy bone health1

Epilepsy & Bone health

  • Altered bone density due to AED’s is associated with:

    • Phenytoin (dilantin)

    • Carbamazepine (tegretol)

    • Barbiturates

    • Valproate (depakote)


Epilepsy bone health2

Epilepsy & Bone health

Prevention and therapy >6mo AEDs

-exercise, balanced diet, stop smoking, moderate alcohol, moderate caffeine

-calcium and vitamin D supplements

-measure Ca, ALP, 25-hydroxy vit D yearly

- Baseline DXA scan


Epilepsy bone health3

Epilepsy & Bone health

Refer for possible treatment to endocrinologist if:

  • osteopenia/osteoporosis

  • Abnormal calcium or vit D levels

  • fracture


Epilepsy and women s health

THANK YOU!

Northeast Regional Epilepsy Group

epilepsygroup.com


  • Login