Doctors treating female epilepsy patients have to consider specific hormonal situation

Doctors treating female epilepsy patients have to take account of the specific hormonal situation in women. Such an approach can often reduce the limitations imposed by the disease. This is the conclusion reached by Sabine Weil of Munich University and her co-authors in the latest issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2010; 107(45): 787-93).

Around 400 000 women in Germany suffer from epilepsy. Of every 1000 children, three or four are born to mothers with this disease. To establish how best to treat women with epilepsy, the authors evaluated recommended guidelines and the international literature on conception and pregnancy, taking in contraception, hormonal influences, and choice of medication.

The advised treatment for women with epilepsy who want to have a child includes prophylactic folic acid, beginning before conception and continuing up to the end of the first trimester of pregnancy. Unless there is no alternative, these women should not be started on the active substance valproate because of its potential teratogenicity. It must also be taken into account that polycystic ovary syndrome is observed more frequently in women with epilepsy who are taking this antiepileptic drug (AED).

Furthermore, the authors found that some AEDs may weaken or even abolish the effect of contraceptives. Conversely, oral contraceptives can lower the concentration of antiepileptic medications. Postmenopausal women on long-term medication for epilepsy should have their bone density measured at regular intervals, because every second woman in this group suffers from AED-associated osteopathy.