Recommendations for the care of women with epilepsy
Patricia E. Penovich, MD
Minnesota Epilepsy Group, P.A., St. Paul, MN
Karen E. Eck, MS, FNP
Columbia University Neurological Institute, New York, NY
Vasiliki V. Economou, MD
Neurological and Epilepsy Consultants, Hayward, CA
Correspondence: Patricia E. Penovich, MD, Minnesota Epilepsy Group, P.A., 310 Smith Avenue N., Suite 300, St. Paul, MN 55102–2383; e-mail: email@example.com
Dr. Penovich receives grants/research support from RW Johnson, Pfizer, UCB Pharma, Novartis, GlaxoSmithKline, and Elan; is a consultant for GlaxoSmithKline and Elan; and is on the speakers' bureau for RW Johnson, UCB Pharma, Novartis, Shire, Elan, and GlaxoSmithKline.
Ms. Eck and Dr. Economou have indicated they have nothing to disclose.
The clinical care of women with epilepsy entails special considerations over the life span. Endogenous depression is more prevalent in persons with epilepsy than in the general population and may be unrecognized. Seizure frequency may be influenced by hormonal fluctuations, as reflected by catamenial patterns in up to 25% of women and by changes at menopause. Fertility is lower in women with epilepsy. These women should be evaluated for anovulatory cycles and particularly for polycystic ovary syndrome, with its attendant health risks. It is important to provide folate supplementation during the childbearing years and to evaluate bone health throughout life, providing calcium and vitamin D supplementation when indicated. Particular consideration is indicated before conception and during pregnancy to minimize both potential teratogenicity secondary to antiepileptic drugs (AEDs) and the risks that seizures pose to fetus and mother. At delivery, vitamin K is indicated. Some infants may need to be monitored for AED withdrawal, while others may require a perinatal team if malformations are identified in utero. Breast-feeding is possible, with sedation rarely being a problem. Recognition, evaluation, and management of these issues will minimize the negative impact of epilepsy and improve lifelong quality of life.