Women and Epilepsy

Epilepsy has several implications on your health if you are a woman. The Mount Sinai Medical Center has experts specially trained to work with these issues.

Epilepsy and menstruation
Hormones can affect epilepsy, and a significant number of you may experience worsened seizures at the time of your period. If a pattern emerges with accurate logging of seizures and menses (catamenial), increased doses of anti-epilepsy medication can be tried, based on the individual’s monthly cycle. There is no FDA-approved treatment for catamenial epilepsy.

Epilepsy and oral contraceptives
If you are taking oral contraceptives, be aware that many anti-epileptic drugs interfere with their efficacy. This is particularly true of Carbamazepine, Phenytoin, Phenobarbital, Primidone, Topiramate, and Oxcarbazepine. To be safe, use a barrier method of birth control as back-up to prevent unwanted pregnancy.

Epilepsy and pregnancy
If you wish to start a family, talk to your doctor. While many anti-epileptic drugs may slightly increase the risk of birth defects, the vast majority of women with epilepsy have healthy babies. Newer prospective data is redefining which drugs are safer; Lamotrigine and Carbamazepine are relatively safe. Valproic acid, for instance, has a higher incidence of major birth defects compared to other anti-epileptic medications. Whenever possible, it’s best to take one medicine if you are considering pregnancy rather than two or more. If you are considering pregnancy, talk to your neurologist before conception so that adjustments can be made to your anti-epileptic regime. Any woman of childbearing age taking anti-epileptic medication should receive folic acid supplementation to prevent neural tube defects.

You may wish to stop taking your epilepsy medication during pregnancy. This is not a good idea if there is any reasonable chance of a generalized tonic clonic convulsion, as this can be very harmful to both you and the fetus. On the other hand, if you are pregnant, folic acid supplementation should be taken throughout pregnancy along with your medication to prevent neural tube defects.

Epilepsy and breastfeeding
There are some conceivable risks of breastfeeding if you are on anti-epileptic medication and breastfeeding can pose a risk to your child. Newer, less protein-bound medications carry a greater risk of transmission through breast milk. Despite the possible risks, the proven benefits of breastfeeding, such as reduced risk of immunological mediated disorders, and enhanced cognitive abilities, are compelling. The American Academy of Neurology recommends breastfeeding for women with epilepsy.

We can help

Our epilepsy experts have extensive experience in women’s health issues. The Mount Sinai Epilepsy Center is conveniently located on the Upper East Side of New York City. Please call us at (212) 241-2627 to schedule an appointment.