Epilepsy and the medications used to control seizures can affect a woman's s
Epilepsy and the medications used to control seizures can affect a woman's sexual health. Infertility, sexual dysfunction, higher rates of birth defects, and even osteoporosis are real issues for women with seizures.
While we may know more now than in the past about women with epilepsy, many misconceptions still persist.
"Informal surveys at both the local and national levels show that women with epilepsy consistently report a lack of knowledge about the difficulties they face," says Patricia Shafer, RN, MN, past chairman of the professional advisory board of the Epilepsy Foundation, who herself suffers from the disorder. "And a survey of health-care professionals, conducted a few years ago, revealed a lack of knowledge or uncertainty about what to do in terms of pregnancy management or problems of sexuality in such cases."
Though Shafer and other experts who spoke with WebMD agree that strides have been made in understanding the unique problems facing women with epilepsy in the past few years, they point to a new dilemma: Getting the message out to general care practitioners and their patients.
"Many women tell me they're aware of [some of the new findings]," says Shafer, who is also an epilepsy nurse specialist in the Comprehensive Epilepsy Center at Beth Israel Deaconess Medical Center in Boston. "But they don't follow through."
Alison Pack, MD, assistant professor of clinical neurology at Columbia University in New York, agrees. She and others are channeling their efforts at spreading the word on three of the main problems women with epilepsy face: reproductive health; bone health, particularly as a woman approaches menopause; and pregnancy.
Readdressing Reproductive Health
No one really knows exactly how seizures affect reproductive health, but there seems to a hormonal connection, experts say. According to Pack, the female hormones estrogen and progesterone act on certain parts of the brain where partial seizures often begin. Estrogen excites these brain cells and can increase the risk of seizures, while progesterone can inhibit or prevent seizures. Not all women with epilepsy develop seizures during their periods, and it is not clear why some women are more at risk.
"Since progesterone levels drop during menses, that may render a woman more susceptible to a seizure during that time period," she explains.
In Boston, Andrew Herzog, MD, director of the Neuroendocrine Unit at Beth Israel Deaconess Medical Center, is working on a large National Institutes of Health-sponsored study designed to provide new answers. While final answers are still years away, preliminary evidence suggests that giving progesterone during menstruation may help to assuage hormone-related seizures.
But not all the news is good: Other studies have shown that some older epilepsy drugs, particularly valproate (sold under the brand names Depakote, Depakene, and Epivil), can interfere with ovulation, Pack tells WebMD. And that, in turn, can lead to infertility and long-term health problems, including high cholesterol levels, certain female-specific cancers, and diabetes, she says.
And the list doesn't end there: "Women taking valproate also report excess weight gain and hair growth," Pack says. Also, a recent study at Columbia University showed that women who took valproate at any time during the past three months were at increased risk of developing cysts in their ovaries.
"The bottom line," Pack says, "is that I tend not to prescribe valproate as a first-line drug for most women with epilepsy who are in their reproductive years. That's not to say that valproate is not a good drug, but with so many other choices available, [for these women] I tend to pick something that won't have these side effects."
While a variety of factors need to be considered when choosing a medication to control seizures in women with epilepsy, Pack says many neurologists have indicated a preference for Lamictal due to its relatively safe side-effect profile.
According to the Epilepsy Foundation, Lamictal neither increases the breakdown of female hormones nor interferes with the effectiveness of hormonal birth control, unlike other seizure medications.
But for women with epilepsy who also suffer from migraine headaches, Topamax is usually considered the drug of choice because of its headache-relieving properties, Pack says.
