The treatment of women with epilepsy.
BACKGROUND
Women with epilepsy and their doctors are often unsure of the implications of the disease and the limitations it causes. There is a major need for counseling.


METHODS
Selective review of the literature as of November 2009.


RESULTS
Recommendations on pregnancy and childbearing for women with epilepsy can be found in the guidelines issued by the German Societies of Neurology and Epileptology and by the American Epilepsy Society. Only low-level evidence is available on other relevant questions, including contraception, the influence of hormones on epilepsy, and the influence of antiepileptic drugs on endocrine and bone metabolism, because of a lack of controlled studies. Polycystic ovarian syndrome is more commonly seen in women with epilepsy who take valproate. Antiepileptic drugs that induce CYP3a can diminish the efficacy of oral contraceptives; conversely, oral contraceptives can markedly lower the blood levels of antiepileptic drugs. According to the most recent studies, the risk of congenital malformations and spontaneous abortions is 1% to 2% in the normal population and 3% to 9% in the offspring of women with epilepsy who are taking antiepileptic drugs. Women with epilepsy who want to have children are currently advised to take folic acid prophylactically starting before conception and until the end of the first trimester. New mothers with epilepsy are advised to breastfeed their children.


CONCLUSIONS
Proper treatment and counseling of women with epilepsy, with due attention to aspects that are specific to women patients, can reduce the limitations to which they are subject in everyday life.
Klinikum der Universität München - Großhadern, München, Germany.
Sabine
S
Weil
Charlotte
C
Deppe
Soheyl
S
Noachtar
D000014:Abnormalities, Drug-Induced / Q000209:etiology / Q000517:prevention & control; D000022:Abortion, Spontaneous / Q000139:chemically induced; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use*; D003276:Contraceptives, Oral / Q000008:administration & dosage / Q000009:adverse effects; D051544:Cytochrome P-450 CYP3A / Q000378:metabolism; D004347:Drug Interactions; D004790:Enzyme Induction / Q000187:drug effects; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005858:Germany; D006801:Humans; D007231:Infant, Newborn; D011085:Polycystic Ovary Syndrome / Q000139:chemically induced / Q000517:prevention & control; D016742:Preconception Care; D011247:Pregnancy; D012307:Risk Factors
D000927:Anticonvulsants; D003276:Contraceptives, Oral; D005492:Folic Acid; C104464:CYP3A protein, human; D051544:Cytochrome P-450 CYP3A