Polytherapy increases the risk of infertility in women with epilepsy

Sukumaran, Sajith; Sarma, P. S.; Thomas, Sanjeev V

doi:10.1212/wnl.0b013e3181f73673

Cited by 80 publications

(39 citation statements)

References 16 publications

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“…An important contribution to the discussion of fertility in epilepsy thus far is from the Kerala Registry of Epilepsy and Pregnancy. 103 In this registry, young women with epilepsy are followed prospectively and generally try to become pregnant following marriage; a 38% infertility rate was found, and this increased rate of infertility was associated with antiepileptic drug polytherapy versus monotherapy. Several biological reasons could cause decreased fertility in women with epilepsy, including premature ovarian failure, increased rates of anovulatory cycles, and a frequent occurrence of PCOS.…”

Section: Effects Of Antiepileptic Drugs and Seizures On Reproductive mentioning

confidence: 99%

Neuroendocrine considerations in the treatment of men and women with epilepsy

Harden

Pennell

2013

The Lancet Neurology

118

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Complex, multidirectional interactions between hormones, seizures, and the medications used to control them can present a challenge for clinicians treating patients with epilepsy. Many hormones act as neurosteroids, modulating brain excitability via direct binding sites. Thus, changes in endogenous or exogenous hormone levels can affect the occurrence of seizures directly as well as indirectly through pharmacokinetic effects that alter the concentrations of antiepileptic drugs. The underlying structural and physiological brain abnormalities of epilepsy and the metabolic activity of antiepileptic drugs can adversely affect hypothalamic and gonadal functioning. Knowledge of these complex interactions has increased and can now be incorporated in meaningful treatment approaches for men and women with epilepsy.

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Section: Effects Of Antiepileptic Drugs and Seizures On Reproductive mentioning

confidence: 99%

Neuroendocrine considerations in the treatment of men and women with epilepsy

Harden

Pennell

2013

The Lancet Neurology

118

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“…In this study, WWE exposed to phenobarbital had significant risk of infertility, but no such trend was observed with valproate or other drugs. [4] AEDs can alter the reproductive hormone balance in women by several mechanisms. Valproate is known to alter the sex hormone metabolism and predispose to polycystic ovarian syndrome which in turn could lead to infertility.…”

Section: Infertilitymentioning

confidence: 99%

Managing epilepsy in pregnancy

Thomas

2011

Neurol India

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There are close to one and half million women with epilepsy (WWE) in reproductive age group in India. WWE have several unique gender-specific problems in the biological and social domains. Women experience more social stigma from epilepsy and have more difficulty with education and employment. They have more difficulty to get married and sustain successful family life. Reproductive hormones like estrogen and progesterone have opposing effect on seizure threshold. WWE have increased risk of infertility. About 10% of their babies may have major congenital malformations. Most of the adverse biological outcomes for WWE are related to adverse effects of antiepileptic drugs (AEDs). Traditional AEDs like phenobarbitone and sodium valproate are probably associated with increased risk of fetal malformations or other adverse fetal outcomes. Polytherapy and use of high dose of any AED is associated with higher risk fetal complications. It is very important that all WWE have a preconception evaluation done by a neurologist, when the need to continue AEDs or possibility of reducing AED load could be assessed. All WWE need to take folic acid 5 mg daily during preconception period and pregnancy. They should undergo a detailed screening for fetal malformations between 12 and 18 weeks of pregnancy. The neurologist, gynecologist, imageologist and pediatrician need to work as a team while managing pregnancy in WWE. It is important to reassure WWE and their relatives that pregnancy is safe in WWE and their children are healthy in more than 90% instances.

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“…An Indian study that included women with validated epilepsy, reported AED polytherapy as a major risk factor for lack of conception, but this study did not compare birth rates to controls (Sukumaran et al. 2010). However, other studies indicate that controlling for comorbidities may be of greater significance regarding fertility rate than the epilepsy per se (Jalava and Sillanpaa 1997; Olafsson et al.…”

Section: Introductionmentioning

confidence: 99%

Age‐specific birth rates in women with epilepsy: a population‐based study

et al. 2016

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ObjectiveThe aim of this study was to investigate birth rates and use of hormonal contraception in different age groups among women with epilepsy (WWE) in comparison to women without epilepsy.Materials and MethodsDemographic data and medical information on more than 25,000 pregnant women (40,000 births), representing 95% of all pregnancies in Oppland County, Norway, were registered in the Oppland Perinatal Database in the period 1989–2011. Data were analyzed with respect to epilepsy diagnoses, and 176 women with a validated epilepsy diagnosis (303 pregnancies) were identified. Age‐specific birth rates in these women were estimated and compared with age‐specific birth rates in women without epilepsy in the same county.ResultsIn WWE over 25 years of age, birth rates were significantly lower than in those of the same age group without epilepsy. In women below 20 years of age, birth rates were similar in those with and without epilepsy. The use of hormonal contraceptives prior to pregnancy was lower among WWE under 25 years than in the corresponding age group without epilepsy.ConclusionsHealth professionals who counsel WWE who are of fertile age should be aware of the strongly reduced birth rates in WWE over 25 years of age, and the lower rates of use of contraceptives among young WWE.

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Polytherapy increases the risk of infertility in women with epilepsy

Abstract: More than a third (38.4%) of WWE had infertility. The important predictors of infertility were exposure to multiple AEDs, older age, and lower education.

Cited by 80 publications

References 16 publications

Neuroendocrine considerations in the treatment of men and women with epilepsy

Neuroendocrine considerations in the treatment of men and women with epilepsy

Managing epilepsy in pregnancy

Age‐specific birth rates in women with epilepsy: a population‐based study

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