Women and Epilepsy: Taking Care of Yourself Joyce Liporace, M.D. Jefferson Medical College Department of Neurology
Today’s Topics <ul><li>Bone Health </li></ul><ul><li>Sleep </li></ul><ul><li>Exercise </li></ul><ul><li>Nutrition </li></u...
Bone Health- Why should you care? <ul><li>People with epilepsy are at increased risk for osteoporosis and fractures. </li>...
AEDs are associated with Bone  Disease <ul><li>Bone loss and fracture were reported with Phenobarbital, Mysoline, and Dila...
Bone Health <ul><li>The epilepsy drugs reduce levels of Vitamin D </li></ul><ul><li>This leads to decreased absorption of ...
Bone Health <ul><li>Women reach peak bone mass by age 25. </li></ul><ul><li>After age 25, we lose 1% of bone each year, un...
Bone Health-Risk Factors <ul><li>Gender </li></ul><ul><li>Race </li></ul><ul><li>Limited weight-bearing exercise </li></ul...
Bone Health <ul><li>Few patients with risk factors for bone disease are offered screening. </li></ul><ul><li>If diagnosed ...
Bone Health Screening <ul><li>DEXA scan (dual X-ray absorptiometry) </li></ul><ul><li>It takes less than 10 minutes, no ne...
Bone Health <ul><li>Metabolic bone disease is common in   adults with epilepsy. </li></ul><ul><li>Both men and women are a...
Bone Health-Treatment <ul><li>Calcium 1,200-1,800 mg/day and  Vitamin D 800 IU/day. </li></ul><ul><li>Exercise is importan...
QUIZ <ul><li>How much calcium (mg) is in the following?: </li></ul><ul><li>Yogurt, nonfat, plain, 8 oz </li></ul><ul><li>S...
Bone Health-Suggestions <ul><li>Ask your Doctor for a DEXA scan </li></ul><ul><li>Make sure you are getting enough Calcium...
Sleep <ul><li>Sleep may affect seizures </li></ul><ul><li>Quality sleep is essential for patients with epilepsy </li></ul>...
Sleep <ul><li>During sleep, brain waves become very rhythmic.  Some people will have seizures only during sleep. </li></ul...
Sleep <ul><li>The older epilepsy medications affect sleep architecture-they reduce the deeper stages of sleep.  The newer ...
Sleep Suggestions <ul><li>Take to your doctor about your sleep </li></ul><ul><li>If you snore or have disturbed sleep, you...
Sleep Suggestions <ul><li>Try to avoid sleep deprivation </li></ul><ul><li>Determine how much sleep is “adequate”  for you...
Exercise <ul><li>Being physically fit is good for everyone! </li></ul><ul><li>Jogging, tennis, golf, basketball, softball…...
Exercise <ul><li>12 Week Study Exercise Program for Epilepsy Patients:  </li></ul><ul><li>Supervised Exercise program thre...
Exercise and Seizures <ul><li>Precipitation of seizures by exercise has been described, but it is unusual </li></ul><ul><l...
Exercise Suggestions <ul><li>Avoid strenuous exercise and know your limitations. </li></ul><ul><li>Take frequent breaks. <...
Nutrition <ul><li>It is important to eat a balanced diet and have meals at regular times </li></ul><ul><li>It is very rare...
Vitamins <ul><li>Vitamins are chemicals that are required in tiny amounts to maintain normal cell function. </li></ul><ul>...
Vitamins <ul><li>Epilepsy medications may interact with vitamins in the body. </li></ul><ul><li>The older medications redu...
Epilepsy Medications and Folic Acid <ul><li>Some epilepsy medications reduce folic acid. </li></ul><ul><li>Folic acid is i...
Minerals <ul><li>Minerals are essential nutrients. </li></ul><ul><li>Low levels of some minerals (calcium, sodium, magnesi...
Calcium Requirements <ul><li>Average Calcium intake for adult women in the US is 800 mg/day </li></ul><ul><li>The requirem...
Magnesium <ul><li>Low levels of magnesium may lead to seizures (and headache). </li></ul><ul><li>Low magnesium can lead to...
Herbal Medicines <ul><li>Herbal products in the US are considered dietary supplements are are not regulated as medicines. ...
Omega-3 Fatty Acids <ul><li>Fish oils </li></ul><ul><li>Reduced seizures in patients that consumed 5 grams of spread at ev...
Herbal Medicines to Avoid <ul><li>Ephedra or Ma Huang </li></ul><ul><li>Caffeine </li></ul><ul><li>Gingko </li></ul><ul><l...
Resources available for women with epilepsy <ul><li>Epilepsy Foundation of America  www.efa.org </li></ul><ul><li>American...
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Women and Epilepsy: Taking Care of Yourself

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Women and Epilepsy: Taking Care of Yourself

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

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