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New Guidelines Offer Recommendations for Women with Epilepsy
ST. PAUL, MN (October 20, 1998) ñ New guidelines may help women with epilepsy make decisions about contraception, pregnancy and breast-feeding while managing the disease. The guidelines were issued by the American Academy of Neurology in the October issue of its scientific journal, Neurology.
"The issues are complex for the more than one million women with epilepsy in the United States," said neurologist and co-author Catherine Zahn, MD, of the University of Toronto. "Many women and their health care providers need more information about these issues. ItÃs heartbreaking to hear about women whoÃve been told they should never have children because of their epilepsy or their medications."
The issues include:
Birth defects ñ The drugs women take to control their seizures can increase the risk of birth defects. The risk of major defects is two to three times higher than the general population risk of approximately two percent. That risk must be weighed against the risks of seizures to mother and fetus, Zahn said.
"Overall, women should be optimistic," she said. "Most women with epilepsy who become pregnant will have successful pregnancies and healthy babies."
Recommendations: ∑ Using only one antiepileptic drug should be the goal of women of childbearing age, as women taking multiple medications may be at higher risk for children with birth defects. ∑ All women of childbearing age should take folic acid supplements; this recommendation is especially important for women with epilepsy, Zahn said. Folic acid supplementation has been shown to decrease the risk of neural tube defects such as spina bifida in infants of women without epilepsy. Women taking some antiepileptic drugs have an increased risk of having a child with this defect.
Contraception ñ Some epilepsy drugs can decrease the effectiveness of oral contraceptives. "Even given this reduced effectiveness, oral contraceptives are still as effective as IUDs and more effective than barrier methods such as condoms, when user error is factored in," Zahn said.
Recommendation: ∑ Women and their doctors should discuss this decreased effectiveness in determining the preferred method of birth control.
Breast-feeding ñ As with all medications, epilepsy drugs will appear in small amounts in breast milk, but this usually does not affect the baby.
Recommendations: ∑ Overall, the benefits of breast-feeding for the infant and the mother are felt to outweigh the small risk of adverse effects due to epilepsy drugs, Zahn said, and breast-feeding can be advocated as an option for women with epilepsy. ∑ Drugs that are sedating for the mother may cause drowsiness and poor feeding in the baby; those babies should be closely monitored.
Research ñ The report also calls for more research in several areas. ∑ For example, information isnÃt available regarding the risk of birth defects with several new drugs approved for use in epilepsy in the last five years. ∑ In another area, many women report that changes in their seizure frequency are related to their menstrual cycle. "Animal studies have shown that estrogen can increase brain seizure activity and progesterone can suppress this activity," Zahn said. "But not enough research has been done on this relationship and how it could be manipulated to reduce seizure frequency in some women."
Researchers also recommend that women with epilepsy develop and maintain a strong relationship with a neurologist or other health care professional knowledgeable about these issues.
To develop the guidelines, researchers conducted a search of 30 years of scientific literature for information on women with epilepsy. The American Academy of Neurology developed the guidelines in conjunction with the American Epilepsy Society, the Epilepsy Foundation of American and the Child Neurology Society.
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