Women differ from men with the same disorder and epilepsy is no exception. For women, hormonal changes during puberty, pregnancy, and menopause may affect presentation and treatment of a seizure disorder compared to men.
Seizure frequency can change during puberty, menstrual cycles, pregnancy, and menopause.
Up to 30 percent of women have an increase in seizures related to the menstrual cycle during the premenstrual period and ovulation called catamenial seizures. During this time progesterone levels drop and estrogen levels increase. Careful evaluation by an epilepsy specialist based on seizure patterns and hormonal testing can identify whether a woman with epilepsy has menstrually related seizures. If standard anti-seizure medications are ineffective some individuals may be candidates for natural progesterone supplement to control seizures.
Epilepsy and pregnancy: Once considered medically unsafe for women with epilepsy to become pregnant, ongoing medical data has shown that over 90 percent of women with epilepsy have a normal pregnancy with good medical care. An epilepsy specialist knowledgeable in women’s issues can optimize pregnancy “fitness” and increase chances for a successful outcome. During pregnancy there are many changes in the body such as increased body fluid, weight gain, increased liver metabolism, and increased excretion by the kidney. All of these changes affect absorption of medication and seizure control.
Epilepsy physicians can select the most effective and safe medication and closely monitor medication levels during pregnancy. This tailored care balances mother’s seizure control and baby’s exposure to seizure medication. A team approach is taken for both neurologic and obstetric care. Patients are followed by a specialized group of obstetricians called maternal fetal medicine with expertise in evaluation and testing of women with epilepsy and other medical illnesses. Medical care extends into the post-partum period by balancing the benefits of breastfeeding while limiting medication exposure to baby.
Menopause and epilepsy: Hormonal effects on seizures extend beyond puberty and pregnancy and well into menopause. For example, peri-menopuase and menopause can affect seizure pattern in those with a previous history of menstrually related seizures (catamenial epilepsy). In fact those with catamenial epilepsy can have an increase in seizures during peri-menopause and decrease in seizures during menopause due to the pro-seizure effect of estrogen levels that decrease during menopause.
Bone mineral density also decreases with age making all individuals at risk for fractures. However, women are particularly susceptible to fracture risk with aging due to the loss of protective effect of estrogen. In fact, women with epilepsy on certain seizure medication are at even increased risk. Certain seizure medications break down vitamin D which is needed along with calcium to build strong bones. An epilepsy specialist can choose an appropriate medication with potentially “bone sparing” effect to maximize bone density and decrease fracture risk while still maintaining good seizure control.
At Weill Cornell Medicine, care for women with epilepsy is tailored throughout the lifespan.