This document discusses several key areas related to women and epilepsy, including the effects of antiepileptic drugs (AEDs) on appearance, the relationship between female hormones and seizure control, fertility, contraception, and pregnancy considerations. Specifically, it notes that certain AEDs can cause hirsutism, weight changes, and menstrual irregularities. It also discusses how estrogen and progesterone levels impact seizure frequency and the risk of birth defects associated with taking AEDs during pregnancy. The document recommends consultation with a neurologist or obstetrics specialist before and during pregnancy.
1. Women and Epilepsy
The main areas to consider are:
AEDs and appearance
Female hormones and seizure control
Fertility
Contraception
Pregnancy
Phenytoin therapy in childhood can cause hirsutism, gingival hyperplasia and coarsen of facial features. Sodium
valproate can cause hair loss, acne and hirsutism. Sodium valproate can also stimulate appetite leading to
obesity, as can vigabatrin, gabapentin and pregabalin.
Conversely, topiramate can cause significant weight loss
Experimental evidence from animal studies suggests that the change in seizure frequency during the menstrual
cycle may be related to the relative oestrogen and progesterone concentrations, with oestrogens being
considered to have pro-convulsant and progestogens anticonvulsant properties, respectively.
A reasonable treatment option in women who develop PCOS and/or ovulatory dysfunction while taking valproate
is to consider discontinuation of the drug and treatment with an alternative AED, if possible.
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2. The AEDs phenobarbital, primidone, phenytoin, carbamazepine, topiramate and eslicarbazepine acetate are
inducers of the hepatic P450 microsomal isoenzyme CYP3A4 which is responsible for the metabolism of
oestrogens and progestogens. This results in increased metabolism of the combined oral contraceptive pill and
can lead to failure of OCP.
Obstetric/neurology pre-conceptual counselling service should be available to allow rapid assessment of women
actively contemplating pregnancy and to coordinate care during pregnancy. The risk of major congenital
malformations is at least doubled (4-9%) in women receiving AEDs, compared with the general population (2-3%)
must be discussed.
The prescription of folic acid before conception and at least until the end of the first trimester is recommended in
patients taking antiepileptic medication, as it is for all women. It causes an increased risk of neural tube defect in
children born to mothers taking AEDs, in particular, sodium valproate and carbamazepine.
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