Hormones such as estrogen and progesterone play a role in epilepsy in women. Estrogen can lower the seizure threshold while progesterone may help reduce seizures. The ratio of estrogen to progesterone over the menstrual cycle influences seizure occurrence for some women. Treatment may involve adjusting epilepsy medications during expected hormone fluctuations or using progesterone supplements. Birth control choice needs consideration of potential interactions with anti-seizure medications. Premenstrual syndrome and polycystic ovarian syndrome are also linked to seizures in women.

1. Overview of Hormones and Epilepsy Joyce Liporace, M.D. Women’s and Men’s Conference May 1, 2010

8. Anatomic Changes with Estrogen-Dendritic spines Neurons from a rat embryo Left: Estrogen supplement Right: Control

12. Normal cycles 21-35 days, bleeding 2-6 days Day 1 = First day of bleeding

28. Attention Women with Epilepsy! Despite the importance of birth control to women of reproductive age, there has been little formal investigation of the safety and effectiveness of birth control methods in women with epilepsy. To remedy this, doctors from Harvard and Columbia University Medical Schools have developed a website that offers a survey to help us gain more knowledge and some educational material that will be updated regularly to provide the latest information. The ultimate goal is to develop guidelines for the selection of safe and effective birth control methods and to make sure that the best forms of birth control become available to women with epilepsy in all communities of our society. Go to www.epilepsybirthcontrolregistry.com , take our survey and then catch up on the latest information about birth control for women with epilepsy. LEARN MORE ABOUT YOUR BIRTH CONTROL OPTIONS!

39. Vicious Cycle Insulin Resistance Increased Androgen Production Weight Gain Anovulation

40. PCOS and PCO: General Population and Epilepsy Prevalence (%) PCOS PCO Genton P, et al. Epilepsia . 2001;42:295-304. Dunaif A, et al. Annu Rev Med . 2001;52:401-419. Herzog AG, et al. Epilepsia . 2001;42:311-315. 12% 23% 25% 38% All premenopausal women Women with epilepsy

41. Epilepsy and PCOS Baseline Epilepsy PCOS Treatment of Epilepsy ?

43. Questions???