Management of epilepsy in women

Abstract

There are many aspects to the management of epilepsy in women related to their role in reproduction. Some of these need to be considered in adolescents, some are related to pregnancy, concerning both the mother and her infant, and others with the menstrual cycle and the menopause. This review considers contraception, fertility, teratogenicity, and the use of folic acid. It also discusses the special investigations in pregnancy, hyperemesis, the effect of pregnancy on the control of epilepsy, the effect of seizures on the fetus, a first fit in pregnancy, pseudoseizures, seizures during delivery, vitamin K, breast feeding, postpartum maternal epilepsy, hereditary risks, counselling, catamenial epilepsy, the menopause, and bone density.

Safe use of sodium valproate

“…The safe use of valproate in women of childbearing age is fraught with challenges. 15 Ideally, the indications for using valproate should be reviewed and its risks discussed before pregnancy occurs.…”

Effect of anti-epileptic drugs in pregnancy and teratogenesis

“…The findings of the complications during pregnancy and its outcome are controversial. Some studies have shown increase in seizures during pregnancy with epilepsy(6,7) while some studies have shown no increase in seizure during pregnancy and perpeurim (8).Chances of risk with AEDs are more, the risk being higher with polytherapy as compared to monotherapy (14)(15)(16)(17). Sodium valporate either as monotherapy or as poly therapy increases the risk of foetal malformations (13,18).…”

“…The risk of malformation being higher in women on polytherapy as compared to monotherapy (14)(15)(16)(17). Excess risk was seen in patients using sodium valproate either as monotherapy or sodium valporate on poly therapy (13,18), higher doses implicate with increased risk.…”

Rapid Quantification of Medroxyprogesterone Acetate (MPA) in Human Plasma by LC-MS/MS

“…The described method is appropriate for quantification of MPA in plasma and can be used in investigations for understanding potential drug-drug interactions between MPA and other concomitant medications (11,23). This is an area of interest, since drug-drug interactions may significantly affect drug pharmacokinetics.…”