Women with epileptic seizures
face challenges - from changes in their menstrual cycle to concerns during
pregnancy. And more than one million women and girls suffer seizure disorders
in the US.
While society continues to
discriminate and abuse the affected, organizations like the Epilepsy Foundation
are attempting their best to address the unique health concerns of women with
Women with epilepsy
- Every 1 in 3 women affected with epilepsy suffers the
major risk of depression.
- Increased rate of sexual dysfunction, infertility and
seizures related to the menstrual cycle are epilepsy-related concerns in
- Although pregnancy is possible in women with
epilepsy, it is not encouraged by medical practitioners.
- The bone health in women can be affected by long time
use of certain anti epileptic drugs.
The incidence of epilepsy is reported in both males and females. According to a study found by the Rochester epilepsy study,
the prevalence of epilepsy was slightly higher in males than in females. While
there are about 49 cases per 100,000 person in male the incidence is 41 cases
per 100,000 person in females. The risk of recurrent seizures is similar
between both the sexes.
Childhood absence and syndrome of
photosensitive epilepsy are more common in females. Similarly, genetic
disorders with associated epilepsy and eclamptic seizures in pregnancy can
occur only in women with epilepsy.
Epilepsy and infertility
It is observed in general that women with epilepsy have lowered fertility when compared with other women. Although
it is true that seizures result in abnormal reproductive hormone variations,
social inhibitions are also a cause for lower birth rates in women with
epilepsy. Married women with epilepsy fear seizures during intercourse. Also
marriage occurs at later age when fertility may be less for other reasons as
Fear of the effects of epilepsy and its treatment during pregnancy may also cause women to seek abortions,
contraception and sterilization resulting in infertility.
Menstrual disorders in women with epilepsy
It is estimated that menstrual disorders occur in 1 of 3 women with epilepsy compared to 1 in 7 in the general
population. Abnormal cycle length is seen to occur in one third of women with
There is a link that can be noticed between menstrual cycle and the tendency to have epileptic seizures. During
menarche, FSH and LH and ovarian steroids, estrogen and progesterone increase.
The cyclic increases in estrogen in relation to progesterone trigger off
breakthrough seizures. Seizure types also vary according to hormonal patterns.
While partial seizures worsen in the follicular phase, absence seizures
increase in the luteal phase.
Stress and anxiety are part of premenstrual tension and these can cause triggers for seizures. This is the
reason why premenstrual tension may increase the risk of seizures. In women
with epilepsy, the periods happen more often than every 25 days. A number of
women with epilepsy also suffer unpredictable periods which do not follow any
set pattern. Disturbed seizure pattern and intake of anti epileptic drugs may
be the cause for disturbances in the menstrual cycle.
One possible treatment for catamenial epilepsy is the drug clobazam which should be taken alongside other
anti-epileptic drugs on advice from the health care provider. The water
retention around the time of periods in the body can change the fluid balance
of the body which may make seizures more likely.
Epilepsy and teenage girls
Adolescent and teenage girls with epilepsy often fear ridicule and rejection and there is a tendency for them to
withdraw socially and stay aloof. Supportive parents and peer group can help
young women with epilepsy to become successful adults with normal behavioral
patterns. Professional counseling may also be necessary for some adolescents
along with their family members.
It is better for adolescents with epilepsy to avoid alcohol and drug abuse as these act on the central nervous
system which can worsen epilepsy. Risk of seizure is more for sports personnel
with epilepsy with potential head injury. It is better for them to participate
in less risky activities and use protective head gear as a precaution.
Similarly, those recreational activities that involve water should be carefully monitored. It is recommended
to use showers over tub baths to avoid the potential hazard of drowning
secondary to a seizure.
Bone health and epilepsy
Osteoporosis is the thinning of bones and women are at greater risk of osteoporosis than men. Women with
epilepsy are at particular risk for this condition which is associated with
bone fractures. Bone density and strength decreases when an imbalance in this
cycle causes more bones to break down.
Bone health problems particularly
affect menopausal women and bone deterioration process is accelerated in
menopausal women with epilepsy. Women with epilepsy may do well to take calcium
and calcium rich food coupled with exercises and avoidance of alcohol and
cigarettes. These can help minimize bone loss and osteoporosis.
Medications for epilepsy
The choice of anti epileptic medication depends on the seizure type and also tolerance level to the
medication. While some types of epilepsy respond better to medicine others may
not. When seizure patterns change, certain medications need to be altered.
Although all who take medication need not suffer side effects, there are some who notice symptoms after intake
of medication. There may be weight gain, unrelated to the calories eaten or
weight loss. Undesirable cosmetic effect such as excessive hair growth and
coarsening of features are other side effects of anti epilepsy medication. Mood
changes, depression, illness and stress, inability to concentrate, bone loss
and risk of osteoporosis, and changes in menstrual cycle, and length and
regularity of periods may all result from medication for treatment of epilepsy.
It is best advised to take the least number of
different drugs possible for control of seizures. This is especially applicable
for a woman who has epilepsy and who wants to become pregnant as we cannot
certainly judge what may cause a birth defect.