HEALTH MATTERS: Women with epilepsy need to stay vigilant

From puberty to pregnancy to menopause, women with epilepsy need to be especially vigilant during these times of hormonal change.

By Rajesh C. Sachdeo, M.D. Special to The Packet
    What do Harriet Tubman, Margaux Hemingway and Agatha Christie have in common?
    Aside from all being famous women, they all struggled with epilepsy.
    Today, more than 1 million women and girls across the United States are living with epilepsy, according to the Epilepsy Foundation.
    And while epilepsy affects women differently than it does men, both biologically and socially, it does not prevent them from leading normal lives.
    Epilepsy is a chronic neurological condition that produces sudden disturbances in the normal electrical function of the brain. This causes seizures that affect an individual’s awareness, movement, sensations or behavior.
    During puberty, pregnancy and menopause, frequent shifts in hormonal balance can make epilepsy and other seizure disorders come to the surface in women. Though hormonal changes do not actually cause seizures, estrogen does excite brain cells in the temporal lobe, which can make seizures more likely to occur.
    Many women experience their first defining epileptic seizure during the onset of menstruation, a time when hormones don’t know whether they’re coming or going. While this can be scary for a young girl, once diagnosed, epilepsy can often be managed and controlled through medication.
    What is critical, however, is that all girls and women of childbearing age take precautions to prevent unplanned pregnancy. Research shows that the risk of harm to the fetus rises significantly — up to 20 percent — in women with epilepsy compared to healthy women.
    This in no way suggests that women with epilepsy cannot have children. In fact, the majority of women with epilepsy who choose to conceive go on to have healthy babies. Most doctors recommend, though, that until a woman decides to get pregnant, she use some method of birth control, with hormonal contraception being the most effective. Even then, women with epilepsy may need a higher dose, given that anti-seizure medications often break down the hormones faster than normal. For some women, however, hormonal contraception may not be an effective option.
    When a woman does decide to get pregnant, it is important she talk with her neurologist about adjusting her seizure medications. Pregnancy can impair the absorption of many seizure drugs, decreasing their effectiveness. Additionally, some medications may have an adverse effect on the fetus.
    Nonetheless, it is key to protect a woman from experiencing seizures during pregnancy. Most doctors agree that a seizure is more dangerous to an unborn baby, especially in the last four months of pregnancy, than the seizure medications available to women today.
    During pregnancy, women should visit their neurologist regularly and undergo frequent blood tests and EEGs to monitor their health. After delivery, the risk for seizures shoots up because of lack of sleep, hormonal changes, and an imbalance in medication levels. Doctors will generally adjust medications to minimize those risks.
    Once they bring the baby home, women with epilepsy must be mindful of their own health and the baby’s health. Given that seizures may be triggered by lack of sleep, women should not be shy about relying on friends and family to help take care of the baby so they can get the proper rest. Women should exercise extra caution when carrying and bathing their baby.
    Breastfeeding is often a concern among women with epilepsy. Fortunately, the majority of medications are safe enough to enable women to breastfeed their babies. Research has shown that the tremendous benefits of breast-milk outweigh the minimal risks of passing medication on to the infant.
    When their child-bearing years end and women begin to enter menopause, they face another challenge in managing their epilepsy — osteoporosis. Women with epilepsy are at greater risk for osteoporosis because many common anti-seizure drugs deplete bone density. Doctors may recommend hormone replacement therapy to combat osteoporosis, but women will also benefit from eating a diet high in calcium and Vitamin D.
    From puberty to pregnancy to menopause, women with epilepsy need to be especially vigilant during these times of hormonal change. By monitoring their medications, getting enough sleep, eating a healthy diet and exercising, women with epilepsy can control and manage the disease and lead a happy and successful life.
Princeton HealthCare System, through its Community Education & Outreach Program, will host a discussion, “Women and Epilepsy: What You Should Know,” from 7 to 8:30 p.m. on Tuesday, March 24, at the UMCP Breast Health Center, 300B Princeton-Hightstown Road, East Windsor Medical Commons 2, East Windsor. The program is part of the Meredith Maher Peterson Memorial Lecture Series. To register for the free session or for more information, visit www.princetonhcs.org/ calendar or call 888-897-8979.
Dr. Rajesh C. Sachdeo is board-certified in neurology and psychiatry and a member of the medical staff at University Medical Center at Princeton. He has specialized in treating epilepsy patients for more than 30 years.