Women with epilepsy (WWE) may experience changes in seizure control related to alterations in neuronal excitability mediated by estrogen and progesterone. A third or more of women will reliably note seizures that are linked to menstruation or ovulation. Reproductive hormone-related exacerbation of seizure control is also observed during perimenopause. Seizures and antiepileptic drugs (AEDs) also can adversely affect reproductive health. WWE have higher than expected rates of menstrual disorders and infertility. Enzyme-inducing AEDs interact with hormonal contraceptives, potentially limiting options for birth control. Exposure to AEDs during pregnancy increases the risk of congenital malformations and cognitive impairments in children born to WWE. Chronic AED use increases the risk of vitamin D deficiency, decreased bone quality and density, and fractures. These concerns heighten the need to taper AEDs when appropriate and to manage WWE on the simplest AED regimen that will maintain seizure freedom.
Relationship Disclosure: Dr Noe has received research support from NeuroPace, Inc., for a responsive neurostimulator device trial. Dr Pack's compensation and/or research work has been funded, entirely or in part, by a grant from a governmental organization to her university.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Noe and Pack discuss the unlabeled uses of acetazolamide and medroxyprogesterone acetate for catamenial epilepsy.