Abstract
Personalized treatment for women with epilepsy is essential, and requires thorough
weighing of the risks and benefits of the initial diagnostic and therapeutic options
chosen, with readjustments of the antiepileptic regimen throughout the patient's life.
Approximately one-third of women with epilepsy have a catamenial pattern, and the
most common pattern is an increase in seizure frequency in the perimenstrual phase.
These women are also more likely to experience a decrease in seizure frequency during
pregnancy and menopause. A good treatment option for catamenial epilepsy is still
lacking.
For contraception, an intrauterine device is currently the preferred choice. Prior
to conception, it is advisable to review the known impact of different antiepileptic
drugs on the developing fetus and to optimize the patient's treatment regimen. Pregnancy
registries and observational studies have provided key data and continue to refine
our understanding of the risks to the structural and cognitive development of the
fetus of specific antiepileptic drugs, including polytherapies and newer medications.
Different studies consistently report that valproic acid has notably high relative
risks for congenital malformations, lower IQ, and features of autism. During pregnancy,
there is growing evidence that therapeutic dose monitoring is beneficial for seizure
control. Counseling about seizure safety and minimizing provoking factors during the
peripartum period is important for the patient with epilepsy.
Clinical studies continue to investigate the complex relationship between cycling
sex steroid hormones, epilepsy, and antiepileptic medications, with hopes to better
explain drug clearance changes during pregnancy, changes in seizure frequency, and
neuroendocrine abnormalities. Thorough understanding of these key factors and a continuous
review of literature for updated data on different treatment options will enable optimal
treatment recommendations that will improve the health of women with epilepsy and
their children.
Keywords
epilepsy - women's neurology - women's health - antiepileptic drugs - catamenial epilepsy
- contraception - pregnancy - therapeutic drug monitoring - menopause - breastfeeding
