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Women and Epilepsy: Taking Care of Yourself
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Women and Epilepsy: Taking Care of Yourself


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  • 1. Women and Epilepsy: Taking Care of Yourself Joyce Liporace, M.D. Jefferson Medical College Department of Neurology
  • 2. Today’s Topics
    • Bone Health
    • Sleep
    • Exercise
    • Nutrition
    • Vitamins and Mineral
    • Herbal Medicines
  • 3. Bone Health- Why should you care?
    • People with epilepsy are at increased risk for osteoporosis and fractures.
    • Bone loss is increased by medications that you take to reduce seizures.
  • 4. AEDs are associated with Bone Disease
    • Bone loss and fracture were reported with Phenobarbital, Mysoline, and Dilantin in the 1970’s
    • Bone loss and fracture have more recently been reported with Tegretol and Depakote
    • The new drugs have not been studied (yet)
  • 5. Bone Health
    • The epilepsy drugs reduce levels of Vitamin D
    • This leads to decreased absorption of dietary calcium, increased parathyroid hormone and causes bone loss
  • 6. Bone Health
    • Women reach peak bone mass by age 25.
    • After age 25, we lose 1% of bone each year, until menopause.
    • With menopause, women lose 4-5% of bone each year.
    • Over a lifetime, women lose 45% of vertebral bone and 55% of their femur.
  • 7. Bone Health-Risk Factors
    • Gender
    • Race
    • Limited weight-bearing exercise
    • Low dietary calcium
    • High protein, alcohol, caffeine intake
    • High soda consumption
  • 8. Bone Health
    • Few patients with risk factors for bone disease are offered screening.
    • If diagnosed early, metabolic bone disease can be reversed with treatment and fractures may be prevented.
  • 9. Bone Health Screening
    • DEXA scan (dual X-ray absorptiometry)
    • It takes less than 10 minutes, no needles.
    • Bone mineral density (BMD) of spine and hip are compared to gender matched controls at peak bone mass.
    • There is a 50% increase in fracture for every SD below normal bone
  • 10. Bone Health
    • Metabolic bone disease is common in adults with epilepsy.
    • Both men and women are affected.
    • We suggest screening epilepsy patients with a DEXA scan, after a treatment duration of two years, earlier for those with a low body mass index or other risk factors.
  • 11. Bone Health-Treatment
    • Calcium 1,200-1,800 mg/day and Vitamin D 800 IU/day.
    • Exercise is important!
    • A repeat DEXA scan should be done after 18 months.
  • 12. QUIZ
    • How much calcium (mg) is in the following?:
    • Yogurt, nonfat, plain, 8 oz
    • Skim milk, 8 oz
    • Sardines in oil, drained, 2 oz
  • 13. Bone Health-Suggestions
    • Ask your Doctor for a DEXA scan
    • Make sure you are getting enough Calcium and Vitamin D
    • Stop drinking soda (or at least limit it)
    • Exercise more
  • 14. Sleep
    • Sleep may affect seizures
    • Quality sleep is essential for patients with epilepsy
    • Going for long periods without sleep can increase seizures
    • Sleep disturbance can lead to: daytime drowsiness, worsening memory, poor seizure control
  • 15. Sleep
    • During sleep, brain waves become very rhythmic. Some people will have seizures only during sleep.
    • Sleep can activate seizures and abnormal brain waves-that is why your doctor may order a sleep deprived EEG.
  • 16. Sleep
    • The older epilepsy medications affect sleep architecture-they reduce the deeper stages of sleep. The newer drugs may be less disruptive. A change in dosing schedule may help sleep.
    • Many medications can affect sleep!
  • 17. Sleep Suggestions
    • Take to your doctor about your sleep
    • If you snore or have disturbed sleep, you may need a sleep study
    • In some cases, diagnosis and treatment of a sleep disorder can alleviate seizures
  • 18. Sleep Suggestions
    • Try to avoid sleep deprivation
    • Determine how much sleep is “adequate” for you
    • Have good sleep “hygiene”-with an evening routine.
    • Avoid caffeine in the afternoon and evening
    • Avoid late afternoon naps
  • 19. Exercise
    • Being physically fit is good for everyone!
    • Jogging, tennis, golf, basketball, softball… there are many activities that people with epilepsy can enjoy (safely).
    • Some caution is needed: water skiing, scuba diving, sky diving, boxing, swimming.
  • 20. Exercise
    • 12 Week Study Exercise Program for Epilepsy Patients:
    • Supervised Exercise program three times a week
    • Improved Quality of Life in the exercise group and seizures were not affected (McCauley 2001)
  • 21. Exercise and Seizures
    • Precipitation of seizures by exercise has been described, but it is unusual
    • Be aware of: prolonged hyperventilation (yoga, pilates), increased body temperature
  • 22. Exercise Suggestions
    • Avoid strenuous exercise and know your limitations.
    • Take frequent breaks.
    • Never swim alone and always inform others that you have seizures.
    • Use adequate head protection.
    • Avoid sports with a high risk of head injury.
  • 23. Nutrition
    • It is important to eat a balanced diet and have meals at regular times
    • It is very rare for nutrition to cause a seizure but can be seen with very low blood glucose, low levels of sodium (water intoxication), calcium, magnesium, and low levels of Vitamin B6 in babies.
  • 24. Vitamins
    • Vitamins are chemicals that are required in tiny amounts to maintain normal cell function.
    • Some are made by our bodies, others are made by plants or animals.
    • The only Vitamin deficiency known to cause seizures is Vitamin B6, pyridoxine.
  • 25. Vitamins
    • Epilepsy medications may interact with vitamins in the body.
    • The older medications reduce Vitamin D which lowers calcium absorption.
    • The older drugs may also reduce Vitamin K levels which are important for blood clotting.
  • 26. Epilepsy Medications and Folic Acid
    • Some epilepsy medications reduce folic acid.
    • Folic acid is important for blood cell production and for peripheral nerve function.
    • Low folic acid increases the risk of birth defects.
    • Women of child bearing age should take extra Folic acid.
  • 27. Minerals
    • Minerals are essential nutrients.
    • Low levels of some minerals (calcium, sodium, magnesium) can affect electrical activity of the brain.
    • Deficiency of minerals in the diet are rare.
    • Selenium and Zinc may help to counteract side effects of some medications (hair loss from Depakote)
  • 28. Calcium Requirements
    • Average Calcium intake for adult women in the US is 800 mg/day
    • The requirement is 1,200 to 1,800 mg/day.
    • We only absorb 600 mg at a time.
  • 29. Magnesium
    • Low levels of magnesium may lead to seizures (and headache).
    • Low magnesium can lead to low calcium.
    • It is rare to need magnesium replacement, unless you have a poor diet or chronically abuse alcohol.
  • 30. Herbal Medicines
    • Herbal products in the US are considered dietary supplements are are not regulated as medicines.
    • 30% of Americans use complementary or alternative medicines
    • Their use can pose serious health risks
  • 31. Omega-3 Fatty Acids
    • Fish oils
    • Reduced seizures in patients that consumed 5 grams of spread at every breakfast for 6 months. (Schlanger, Epilepsia 2002)
    • 21 patients-16 patients refused to eat the spread!
  • 32. Herbal Medicines to Avoid
    • Ephedra or Ma Huang
    • Caffeine
    • Gingko
    • Ginseng
    • St. John’s Wort (may alter drug levels)
    • Evening Primrose
    • Borage
  • 33. Resources available for women with epilepsy
    • Epilepsy Foundation of America
    • American Epilepsy Society
    • National Osteoporosis Foundation