February 4, 2023

Filipino Guardian

Sentinels of Filipino Free Press

Epilepsy over a woman’s lifespan

November is National Epilepsy Awareness Month.

Dawn Gosselin was 16 when she had her first seizure. “I was with my high school band at a rest stop in New Jersey on my way home from Washington, DC,” she said. At the time she wrote it as a combination of staying up late with her friends and being busy, but it was more serious than that. She had epilepsy. As far as she knew, no one in Gosselin’s family had epilepsy, so she had no experience of the condition.

Epilepsy is a brain disorder that causes seizures. It affects more than 3 million people in the United States. Seizures can affect the whole body or just part of it and can last from just a few seconds to a few minutes.

Diagnose epilepsy

There can be many causes of seizures. They can be triggered by alcohol withdrawal, high fever, and head injuries, to name a few. But epileptic seizures have no known cause. According to Alison M. Pack, MD, a professor of neurology at Columbia University’s Irving Medical Center, a diagnosis of epilepsy can be made after someone has had two unprovoked seizures. Or if, after a seizure, a magnetic resonance imaging (MRI) or electroencephalogram (EEG) of the brain shows the chance that you will have another seizure is six in ten or more.

women and epilepsy

Epilepsy as a whole affects men and women equally, but there are some specific epilepsy syndromes that are more common in women. One, absence seizures, causes brief lapses of consciousness that look like blank stares. Another is photosensitive epilepsy, in which seizures are triggered by flashing or flickering lights. Gosselin has both. The other, more common, is related to the female hormones that rise and fall throughout the month, estrogen and progesterone. Estrogen can cause seizures and progesterone can work against it. When the seizures are related to menstruation, it is called catamenial epilepsy.

It’s not uncommon for teenage girls to experience epileptic seizures around the beginning of their menstrual period, she added. Gosselin’s daughter, who also has epilepsy, falls into this category. “She was 12 when she had her first seizure, five months before her first period,” Gosselin said.

Choosing a safe and effective contraception

Fertile women with epilepsy should use an effective form of birth control. “That was one of the main rules I grew up with,” Gosselin said. “You can’t have unplanned pregnancies.” Pregnancy is not impossible, but should be planned so that expectant mothers can take medication that controls their seizures but is still safe for the baby.

The oral contraceptive pill is one of the most popular forms of birth control in the United States. But they’re not usually a good option for women with epilepsy. These pills contain estrogen and progestin (a man-made form of progesterone) or progestin only. And according to Pack, many epilepsy drugs produce a liver enzyme that can decrease the effectiveness of oral contraceptives.

Pack believes the best form of birth control for women with epilepsy is the IUD, an intrauterine device. “This is something that is becoming commonly used in the rest of the world and is gaining traction or acceptance in the United States,” Pack said. “IUDs are a very good form of contraception. You are still ovulating and if it is removed you can become pregnant. You don’t have some of the problems [related to stopping the pill].”

There are two types of IUDs – with and without hormones. The IUD releases progestin, but Pack and a colleague conducted a study looking at how the IUD worked in their patients. “We found no effect on seizures or drug levels in this study,” she said.

pregnancy and epilepsy

Most women with epilepsy have successful pregnancies, especially when they are planned. Up to three in 10 have a higher risk of having more seizures, especially in the first and last trimester. But most women who are seizure-free nine months before pregnancy generally remain seizure-free during pregnancy.

That being said, pregnant women with epilepsy still need to be closely monitored by their neurologists. “When I see a person planning a pregnancy or being pregnant, we’re talking about different factors or components of medications,” Pack said. “One is, are your seizures controlled? And second, what are the implications for the developing fetus?”

A grand mal seizure during pregnancy can be harmful to both the mother and the baby, but overall, the medications used to prevent the seizures are fairly safe. Blood levels, which monitor how much drug is in the blood, need to be checked regularly so the drug dose can then be adjusted as needed.

“My seizures were pretty well controlled through both of my pregnancies. I have a 20-year-old son and a 16-year-old daughter,” Gosselin said. “But, full disclosure, the medications I took when I was pregnant are not recommended today [during pregnancy].”

menopause and epilepsy

Many, but not all, women with epilepsy experience changes in their seizures as they approach menopause. Some women whose seizure patterns change during menopause have worse or more frequent seizures, while others have fewer. Women with catamenial epilepsy often have more seizures during perimenopause but fewer during menopause.

Another challenge women with epilepsy face is that they are at increased risk of osteoporosis (weakening of the bones) for two reasons. One is that epilepsy medications can affect your bone density. The other is that estrogen hormone therapy, which can help keep bones strong, is not an option for women with epilepsy because it can increase their risk of seizures.

epilepsy and reproductive disorders

Women with epilepsy have a higher rate of some reproductive disorders, such as:

The exact reason is not yet known, but is probably related to the fact that epilepsy and anti-epileptic drugs can affect sex hormones and fertility. They can also increase your risk of developing PCO and PCOS, especially if the medication contains an ingredient called sodium valproate.

Learning to live with epilepsy

Living with epilepsy has its challenges, but one way to improve your experience is to keep up to date. It is important that women with epilepsy ask questions about their health and continue to do so as they age.

“You are your own advocate. Don’t be afraid to educate yourself and others,” Gosselin said. “It might not only help you, but the next person who needs it.”

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