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The Weill Cornell Medicine Epilepsy Center has an extraordinary track record in diagnosing, treating, and managing epilepsy. We approach each patient holistically — taking the time to understand your condition and customizing a care plan to help you achieve the life you want.

Epilepsy is treated differently depending on a variety of factors, including your age, gender, and lifestyle. Our epileptologists are experts in providing personalized care for all patients.

Epilepsy in Women

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.

Watch how Weill Cornell Medicine helped Carrie control her seizures, live an active lifestyle, and prepare for pregnancy.

Related Treatments
Epilepsy and Trauma

Seizures may occur immediately following a severe head injury. Immediate post traumatic seizures by definition occur within 24 hours of the injury. They have also been referred to as impact seizures. Post traumatic epilepsy refers to seizures which occur about a week to six months after the injury. Seizures may occur even as far out at two to five years after head trauma (late post traumatic epilepsy).

Overall, post-traumatic epilepsy is the most common cause of acquired (not developmental or genetic) epilepsy. It is also the most common cause of epilepsy in young adulthood. 

Factors that increase the risk of post traumatic seizures/epilepsy include more severe head injury, whether there is prolonged loss of consciousness (more than 24 hours) with the initial injury, bleeding in the brain, the presence of a skull fracture, and prior early post traumatic seizures. Seizure medication may control 20 to 40 percent of patients, however some patients may have recurrence when medications are discontinued. Some patients also may be medication resistant and require epilepsy surgery for optimal seizure control.

Related Treatments
Epilepsy in Seniors

People who develop epilepsy in younger years may have it persist into their senior years. Fortunately, epilepsy while young does not lead to other neurological conditions of the elderly, such as Alzheimer’s Disease, Parkinson’s Disease, or stroke. 

For others, epilepsy may not begin until later years. The first seizure in a senior citizen requires immediate medical attention. A neurologist will evaluate the patient for any signs of:

  • Lung, kidney, or liver damage
  • Infection
  • An undiagnosed brain problem, such as a blood clot, tumor, stroke, or dementia
  • Signs that another seizure is more likely to occur (seizure tendency)

Sometimes a seizure is a single occurrence. So, the decision to treat with an anti-epilepsy medication is made only after a discussion with a doctor regarding the risks and benefits. 

If several seizures have occurred, this is considered epilepsy, and some treatment is required. With medical attention to the unique characteristics of epilepsy in seniors, patients can achieve excellent results and quality of life.

Be sure to seek out a neurologist who specializes in treating epilepsy in older patients. These experts, including those at the Weill Cornell Medicine Epilepsy Center, will consider important factors involved in medication therapy, including:

  • Drug-to-drug interactions with other medications
  • Managing medication side effects to improve overall quality of life and independence
  • Monitoring long-term effects of anti-seizure medications, including reducing bone density

In rare cases, medication alone does not stop seizures, so surgery may be necessary to remove the source of the seizures. There is no universally agreed upon age limit for epilepsy surgery, however, surgical risks, due to increased occurrence of complications with age (such as heart, lung, and kidney disease), need to be weighed against the benefits of surgery.

Nerve stimulation, as an alternative surgical treatment for epilepsy, is considered a good option for seniors as there are no drug interactions and no side effects, such as dizziness, with the implantation of the electrical device.

Related Treatments
Epilepsy in Infants, Children and Adolescents