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Changes in seizure patterns may begin with hormonal fluctuations at menarche and continue during the menstrual cycle a,b
30%-50% have epileptic patterns that correspond to their menstrual cycle b,c
Vulnerability to seizures is highest just before and during flow and at ovulation (relatively high estrogen and low progesterone levels)
a Herzog AG, et al. Epilepsia. 1997;38:1082-1088. b Cramer JA, Jones EE. Epilepsia. 1991;32(suppl 6)S19-S26. c Morrell MJ. In: Wyllie E, ed. The Treatment of Epilepsy: Principles and Practice. 2nd ed. Baltimore, Md: Williams & Wilkins; 1997:179-187.
Seizure Frequency in Normal Cycle Average Number of Seizures Per Day Menstrual 0.3 0.4 0.5 0.6 Follicular Ovulatory Luteal * P <0.001 vs. ovulatory or luteal and ovulatory and luteal combined Number of seizures=1324 Number of cycles=98 * * Mean number of seizures/day Herzog AG, et al. Epilepsia. 1997;38:1082-1088.
AED concentration in breast milk related to protein binding 1
PB and other sedating AEDs may cause sedation or poor feeding 1
American Academy of Neurology encourages breastfeeding with close observation of baby 2
Zahn CA, et al. Neurology. 1998;51:949-956.
Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1998;51:944-948.
Menopausal Women Epilepsy Pattern Increase Decrease No change Catamenial pattern Percent of women *Significantly associated with a decrease in seizures ( P =0.013) Harden CL, et al. Epilepsia. 1999;40(10):1402-1407. *