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Women with epilepsy face fertility issues by Heather Woolwine Public Relations The following article is the third in a series highlighting national epilepsy awareness efforts on behalf of the national Epilepsy Foundation and MUSC. This article details issues specifically faced by women who have epilepsy.   Epilepsy may not discriminate between men and women or among races, but women with epilepsy face hormonal, reproductive and parenting issues unlike their male counterparts.   Like all people with epilepsy, women must deal with the social stigma that comes with the condition. They strive for discipline in taking anti-seizure medications regularly, avoiding stress or sleep deprivation, eating regular meals, and minimizing alcohol intake. Women with epilepsy endure driving restrictions and the fear of having seizures in front of family, friends, spouses, peers and colleagues. No one likes to feel out of control, and for women with epilepsy, that fear feeds other worries about discrimination at work, restricted opportunities in life, and finding someone who loves them, seizures and all.   As part of a continuing educational series, Susan Brown, M.D., a former MUSC resident, will conduct a free seminar about women’s issues in epilepsy at the MUSC Harper Student Center from 6:30-9 p.m. Oct. 26. For more information and to register, call 792-3307. From puberty to pregnancy Puberty can be hard enough on a woman, even without the fear of increased seizures. Women with epilepsy not only deal with the everyday hormonal ups and downs, but because of how these hormones interact with the brain, seizures can become more frequent. Estrogen excites brain cells and can make seizures more likely to happen. Progesterone can inhibit or prevent seizures in some women. This is not to say that hormones cause seizures, but they do influence their frequency. Many women with epilepsy see changes in the number or the pattern of seizures around the time of ovulation and menstrual periods.    With the change from girl to woman, women with epilepsy must also consider the implications of anti-seizure medication on birth control methods and possible side effects. Hormonal implants, such as Norplant, may not provide effective birth control protection if a patient is taking certain epilepsy drugs. Birth control pills also are affected by many anti-seizure medications. Rashes, coarsening facial features, hair loss and weight gain are potential side effects that many women deeply fear when taking anti-seizure medications. There’s also the possibility that medications will cause sedation, depression, osteoporosis and polycystic ovarian syndrome.   “Women with epilepsy have higher rates of infertility, depression and suicide,” Brown said. “They frequently have earlier timing when it comes to menopause. Estrogen influences seizures; therefore there is a higher breakthrough of seizures at certain times of the menstrual cycle, despite taking the medication regularly. Women with epilepsy must be vigilant and careful to monitor medication levels, especially during pregnancy.”   For women with epilepsy, motherhood isn’t just about picking out the perfect sleeper set or remembering which questions to ask the obstetrician. The condition can mean much in terms of becoming pregnant, seizure care, and how it affects the baby in and outside the womb.   Women with epilepsy have fewer children than women in the general population. However, it is a common misconception that women with epilepsy should not bear children or should stop taking anti-seizure medications when pregnant. An increased risk of birth defects exists for women with epilepsy who take anti-seizure medication, but this risk is low (4 percent to 6 percent for women with epilepsy compared to 2 percent to 3 percent for the general population). “More than 90 percent of women with epilepsy have perfectly healthy babies,” said Orrin Devinsky, M.D., New York University School of Medicine professor and a national expert on epilepsy.   As for any woman, it is important for women with epilepsy to plan for a pregnancy by taking prenatal vitamins and plenty of folic acid. Pregnancy can influence seizure frequency so women with epilepsy and their physicians must carefully consider anti-seizure medication doses for the duration of the pregnancy.   “Planning a pregnancy is important to choose optimal medications and folic acid intake to prevent neural tube defects,” Brown said. “There are many patients who become concerned with carrying a baby to term, passing epilepsy onto their children, or about the cognitive effects of seizure medication on the fetus. Most women who have epilepsy do not have any unusual problems with their pregnancy.”   Studies do show that women with epilepsy have an increased risk of vaginal bleeding both during and after pregnancy, according to the Epilepsy Foundation’s Web site. “The most important things that women with epilepsy can do to decrease risks to their baby is to reduce stress, take care of their health and nutrition, exercise, and take medications according to their physician’s orders,” Brown said. “It is believed that breastfeeding for women with epilepsy is safe and is generally recommended. All seizure medications will be found in small amounts in breast milk, but this usually does not affect the baby.” Parenthood For any parent with a medical condition, concern increases for the well-being of the child’s health or care. Brown said she sees many patients concerned about having a seizure while holding a child, the effects their medication will have on their ability to interact with their child, and remembering to take their medications while consumed with the demands of parenting.   The Epilepsy Foundation suggests always feeding the baby in a comfortable chair or in your bed, or as the baby grows, secure him or her in an infant seat or highchair to avoid possible risks during a seizure.   Another recommendation is to diaper the baby on the floor, because diaper changing tables could pose a risk to the baby if the mother were to have a seizure while changing a diaper. When a mother with epilepsy is home alone, the group recommends sponge baths instead of baths in the tub. To keep the bundle of joy with her around the house, a mom with epilepsy should consider a small umbrella stroller instead of carrying the baby from room to room. Additional tips include keeping toys and supplies throughout the house and providing a safe enclosed area, like a playpen, for the child to play in. Child-proofing the home is important for all children, not just those whose mother has epilepsy. Safety gates across stairs, locking doors, electrical outlet covers, and child-proof latches are all effective methods. For mothers with epilepsy and busy toddlers, strollers, safety harnesses or a wrist bungee cord could keep them from wandering during a seizure. Menopause Menopause is highly variable for each woman, and in that sense, the experience is the same for women with epilepsy. The average woman experiences a drop-off in estrogen production as she ages. If estrogen production sloughs off, then it’s logical to conclude that women with epilepsy would have fewer seizures. This is not always the case, however. Progesterone, the hormone that seems to prevent some seizures, also sloughs off during this transition period, making it difficult to predict what will happen to individual seizure patterns. Some women have more seizures, others have less, and still others may never note a change.   Women with epilepsy should monitor bone density and carefully consider whether or not hormone replacement therapy is a good option for them. The decision to start this kind of therapy is an individual one, and risks and benefits come with it. It’s important for women with epilepsy to talk with their physician about the best choice for them, dependent on seizure frequency and family history.   For information concerning women with epilepsy, go to http://www.epilepsyfoundation.org/.     Friday, Oct. 20, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.