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Managing Epilepsy in Women

Gerard, Elizabeth E. MD; Meador, Kimford J. MD, FAAN

CONTINUUM: Lifelong Learning in Neurology: February 2016 - Volume 22 - Issue 1, Epilepsy - p 204–226
doi: 10.1212/CON.0000000000000270
Review Articles

ABSTRACT Purpose of Review: Caring for a woman with epilepsy requires familiarity with the implications of antiepileptic drugs (AEDs) for pregnancy and contraception as well as an understanding of the effects of female hormones on epilepsy.

Recent Findings: AED pregnancy registries and prospective studies of cognitive development continue to confirm that valproate poses a significantly increased risk of structural and cognitive teratogenesis. In contrast, data thus far suggest that lamotrigine and levetiracetam are associated with a relatively low risk for both anatomic and developmental adverse effects, although further studies are needed for these and other AEDs. The intrauterine device is a good contraceptive option for many women with epilepsy as it is highly effective and not subject to the drug-drug interactions seen between hormonal contraception and many AEDs. Hormonal-sensitive seizures are common among women with epilepsy; however, highly effective treatments for refractory catamenial seizures are limited.

Summary: Women with epilepsy should be counseled early and regularly about reproductive health as it relates to epilepsy. AED selection for women of childbearing age should take future pregnancies and contraceptive needs into consideration.

Address correspondence to Dr Elizabeth E. Gerard, Department of Neurology, Feinberg School of Medicine, Northwestern University, Abbott Hall No 1114, 710 North Lake Shore Drive, Chicago, IL 60611, e-gerard@northwestern.edu.

Relationship Disclosure: Dr Gerard has received honoraria from the American College of Physicians and research support from the National Institute of Neurological Disorders and Stroke and SAGE Pharmaceuticals. Dr Gerard has served as a research consultant on a trial sponsored by UCB, Inc. Dr Meador serves as a consultant for the Epilepsy Study Consortium and on the editorial boards of Epilepsy and Behavior, Journal of Clinical Neurophysiology, and Neurology. Dr Meador has received travel, meeting, and accommodation compensation from UCB, Inc, and receives research support from the National Institute of Neurological Disorders and Stroke and the Patient-Centered Outcomes Research Institute.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Gerard and Meador report no disclosures.

© 2016 American Academy of Neurology
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