Treatment of Women With Epilepsy

Mona Sazgar, MD, FAES p. 408-430 April 2019, Vol.25, No.2 doi: 10.1212/CON.0000000000000713
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  • Patterns of catamenial epilepsy. A, The normal menstrual cycle. B, The inadequate luteal phase cycle. The three patterns of catamenial epilepsy are (1) perimenstrual (C1, day –3 to 3), (2) periovulatory (C2, day 10 to –13) for the normal ovulatory cycles, and (3) the entire second half of the cycle for inadequate luteal phase (C3, day 10 to 3). Day 1 is the first day of menstrual flow, and day 14 is the day of ovulation.F = follicular phase; L = luteal phase; M = menstruation; O = ovulation. Reprinted with permission from Herzog AG, Seizure.10 © 2007 British Epilepsy Association.

  • Patterns of Catamenial Epilepsya

  • Brain regulation of sex hormones through the hypothalamic-ovarian-pituitary axis. Gonadotropin-releasing hormone (GnRH) produced by the hypothalamus stimulates the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by the anterior pituitary gland. FSH stimulates the growth of ovarian follicles. Estrogen production results in negative feedback, reducing FSH but stimulating GnRH. GnRH stimulation leads to LH surge, ovulation, and conversion of the follicle to corpus luteum. Corpus luteum secretes progesterone, which inhibits GnRH, LH, and FSH production.

  • Suggested Treatment Options in Women With Catamenial Epilepsy

  • Antiepileptic Drugs and Contraceptive Failure

  • Risk of major congenital malformations in women taking an antiepileptic drug (AED) as monotherapy during pregnancy compared with women taking no AEDs based on the data provided by the North American Antiepileptic Drug Pregnancy Registry (NAAPR) (1997–2005).80

  • Effect of Antiepileptic Drugs on Bone Mineral Density and Bone Turnover (Based on Majority of Studies)

  • Recommendations for Women With Epilepsy at Risk of Osteoporosis