Quality of life, epilepsy advances, and the evolving role of anticonvulsants in women with epilepsy

Abstract

In the United States, approximately 1.1 million women of childbearing age have epilepsy. Even though antiepileptic drugs (AEDs) control the seizures of about 80% of patients with epilepsy, the management of women with epilepsy (WWE) presents physicians with unique problems, ranging from the cosmetic consequences of some AEDs (e.g., changes in weight) to the seizures of catamenial epilepsy (apparently related to a relative lack of progesterone during the luteal phase of the menstrual cycle). In addition, the effectiveness of hormonal contraceptives can be reduced by enzyme-inducing AEDs. The pregnancies of WWE present a greater risk for complications: one-quarter to one-third of WWE experience an increase in seizure frequency. In addition, difficulties during labor and adverse outcomes (e.g., fetal mortality and malformations, neonatal hemorrhage, low birth weight, and developmental delay) are more likely. The practitioner must choose a course that both prevents seizures and minimizes fetal exposure to AEDs.