Epilepsy in Women

Menstruation & Catamenial Seizures

Seizure activity worsening, or exacerbation (both frequency and severity) may associate with a woman's menstrual cycle and this are called catamenial seizures. Estimates of the number of women with epilepsy who have catamenial epilepsy range from 10% to 70%. In a small percentage of women, catamenial seizures may occur only during the days just before their periods; for others, during the period itself. 

The fluctuations in female hormones prior to and during menstruation may elevate seizure frequency in some women. Such increase in seizure frequency may be due to higher ratios of estrogen to progesterone. Estrogen lowers seizure threshold making it easier for neurons to misfire. Progesterone raises the seizure threshold making it harder for neurons to misfire. Progesterone has been shown have an antiseizure effect that may be helpful to some women with such epilepsy. Water retention, electrolyte imbalance, emotional instability and even poor sleep are also contributing causes.

Such seizures has been demonstrated in women with simple partial, complex partial, and generalized tonic-clonic seizures. However, different types of seizures may be associated with different phases of a woman's menstrual cycle. 

Menstrual disorders, such as amenorrhea (the absence of menstruation), oligomenorrhea (a scanty menstruation), cycles of irregular length and an absence of changes in cervical mucus have been reported in women with epilepsy, especially those who experience complex partial seizures.

Mood swings associated with catamenial seizures (common in women with temporal lobe epilepsy) are often pronounced prior to and during menstruation and , may be further aggravated by anticonvulsant medication. If mood swings become problematic, it is recommended you discuss adjustments to medication with your physician and/or neurologist. 

Birth Control

Before deciding to use oral contraceptives, women who take anticonvulsant medication should consult with their physician. The effectiveness of birth control pills may be impaired when women take certain types of anticonvulsants. Phenytoin, primidone, valproate and carbamazepine can lower the hormones level in the blood via increase metabolism or increase binding by the protein in the blood. Both often results in the failure of hormonal contraception. Breakthrough bleeding may occur although pregnancy can result without this  sign of warning. Other AED have not yet been found failing hormonal contraception. Your physician may recommend an oral contraceptive with a lower estrogen content, or suggest alternative birth control methods. The effectiveness of hormonal contraceptive remain at approximately the same level as the intra-uterine device and is superior to barrier methods of birth control. Formulation containing at least 50 µg of estradiol or menstranol are more effective. Levonorgestral  implants ( a progestin only formulation) do not appear to be a good alternatives because its efficacy is also reduce in such setting.

Epilepsy and Menopause

Various findings on the effects of menopause on epilepsy:

1. Seizure frequency often decreases, especially if seizures had been related to menstruation. 
2. Epilepsy improves during menopause if epilepsy started later in life, and if seizures have always been infrequent. Sometimes epilepsy may completely disappear.
3. Increases in the number of seizures have been found in women who have frequent tonic-clonic or complex partial seizures. 
4. During menopause, fluid retention may also increase seizure frequency.
5. Occasionally, for unknown reasons, epilepsy may occur for the first time at menopause.
6. Studies indicate that women who experience complex partial seizures have a higher rate of premature menopause than those who have other types of seizures.

Women with Small Children

The safety of babies and small children can be a significant concern to women with epilepsy. Women who experience an aura before a seizure can prepare themselves and their children for the seizure. However, those whose seizures occur irregularly and without prior warning are at a considerable disadvantage.

Recommended Safety Precautions

• When bathing a baby, it is preferable to wash the baby on a mat in the crib, with a bowl of water outside the crib. If you are alone, a baby should not be bathed in an adult or baby bath.
• A well-padded easy chair is a safe, comfortable place to breast- or bottle-feed a baby. If a rocking chair is used, pad the arms with towels and use extra pillows to cushion the child. The baby can also be fed while the mother is lying on her side.
• Ensure that there is a portable crib or playpen on each level of the home.
• Make sure that medications are safely locked away, out of a young child's reach. When the child can understand, explain why you take the medication and tell him or her about any seizure you may have. Children can learn to help you and help care for younger siblings during a seizure.
• Secure an outside play area with a sturdy fence and a locked gate. If taking a young child for a walk in a stroller, attach a safety harness to the child. Discreetly affix a tag or sticker on the stroller with the baby's name and the name of a relative or emergency caregiver to contact in the event of a seizure. If taking a toddler for a walk without a stroller, continue to use a wrist harness until the child is old enough to fully understand that s/he must stay close to you if you have a seizure.

Posted on 6th May 2001