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Women and  Epilepsy   Across the Reproductive Years Blanca Vazquez,MD Director of Clinical Trials Comprehensive Epilepsy program NYU Medical Center
Special Considerations in woman With Epilepsy   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epilepsy and Sexuality
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Puberty ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Polycystic Ovary Syndrome  NIH Diagnostic Criteria   ,[object Object],[object Object],[object Object],Duncan S.  Epilepsia . 2001;42(suppl 3):60-65.
Clinical Features of PCOS   Hyperandrogenism ,[object Object],[object Object],[object Object],[object Object],Lobo RA, et al.  Ann Intern Med . 2000;132:989-993. Hirsutism Acne
AEDs and Contraception ,[object Object],[object Object],[object Object]
Contraception Choices for Women with Epilepsy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Family Planning for Women on Antiepileptic Drugs (AEDs): Interaction With Hormonal Contraception ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*At higher dosage.
Catamenial Seizures ,[object Object],[object Object],[object Object],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.
Treatment of Catamenial Epilepsy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Effects of AEDs on Body Weight ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Biton V.  CNS Drugs . 2003;17(11):781-791.
Effects of AEDs on Body Weight Gain Neutral Loss Valproate Lamotrigine Topiramate Gabapentin Levetiracetam Zonisamide Carbamazepine Phenytoin Felbamate Tiagabine
Retrospective Analysis  Of Bone Density ,[object Object],[object Object],Pack AM, et al.  Epilepsy Behav . 2003;4(2):169-174.
Possible Mechanisms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Feldcamp J, et al.  Exp Clin Endocrinol Diabetes . 2000;108(1):37-43.  Koch KH, et al.  Epilepsia . 1972;13(6):829-834. Onodera K, et al.  Life Sci.  2002;70(13):1533-1542. Valimaki MJ, et al.  J Bone Miner Res . 1994;9(5):631-637.  Vernillo AT, et al.  Matrix.  1990;10(1):27-32.  Weinstein RS, et al.  J Clin Endocrinol Metab.  1984;58(6):1003-1009.
Conclusion ,[object Object],[object Object],[object Object]
Treatment of AED Associated  Bone Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Calcium RDA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fetal Anticonvulsant Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Dilemma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pregnancy Impact on Maternal Seizures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Krishnamurthy KB, et al.  Epilepsia.  2002;43(suppl 7):232-233.
Folate and Neural Tube Defect ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Folate Supplementation ,[object Object],[object Object],[object Object]
North American AED and  Pregnancy Registry ,[object Object],[object Object],[object Object],[object Object]
What Is the Safest AED  in Pregnancy? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Breastfeeding and AEDs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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. *
AEDs and Menopause ,[object Object],[object Object]
  Women Treated with AEDs Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Blanca Vazquez, MD

  • 1. Women and Epilepsy Across the Reproductive Years Blanca Vazquez,MD Director of Clinical Trials Comprehensive Epilepsy program NYU Medical Center
  • 2.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. 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.
  • 13.
  • 14.
  • 15. Effects of AEDs on Body Weight Gain Neutral Loss Valproate Lamotrigine Topiramate Gabapentin Levetiracetam Zonisamide Carbamazepine Phenytoin Felbamate Tiagabine
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29. 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. *
  • 30.
  • 31.

Editor's Notes

  1. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  2. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  3. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  4. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  5. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  6. PCOS: National Institutes of Health Diagnostic Criteria. In the United States, PCOS is defined with diagnostic criteria developed by the National Institutes of Health (NIH) as an ovulatory dysfunction with clinical evidence of hyperandrogenism and/or hyperandrogenemia. 3,4 For the condition to be diagnosed, related disorders, such as those that affect adrenal or thyroid function (eg, androgen-secreting neoplasms), must be excluded. 1-3 The diagnosis of PCOS is generally made through a combination of clinical, ultrasonographic, and biochemical criteria. 2 This definition excludes the finding of polycystic ovaries (PCO), multifollicular ovaries, or hyperandrogenism in isolation. Outside of the United States, the diagnosis is usually based on ovarian morphology, and affected women may be further subgrouped by ovulatory status. Because the anovulatory subgroup may demonstrate more profound insulin resistance, differences in diagnostic criteria may explain many of the divergent findings between US and European studies of patients with this disorder. 3 References 1. Bauer J, et al. Epilepsy Res . 2000;41:163-167. 2. Chappell KA, et al. Ann Pharmacother . 1999;33:1211-1216. 3. Dunaif A, et al. Annu Rev Med . 2001;52:401-419. 4. Duncan S. Epilepsia . 2001;42(suppl 3):60-65. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  7. Clinical Features of PCOS. Hyperandrogenism. Hyperandrogenemia is a key feature of PCOS, and it may appear as hirsutism, acne, male pattern balding, and/or male distribution of body hair. 1 Reference 1. Lobo RA, et al. Ann Intern Med . 2000;132:989-993. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  8. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  9. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  10. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  11. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  12. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  13. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  14. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  15. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  16. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  17. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  18. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  19. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  20. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  21. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  22. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  23. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  24. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  25. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
  26. Blanca Vazquez, MD Women&apos;s Issues in Epilepsy: Across the Reproductive Years
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