Principles of Epilepsy Management for Women in Their Reproductive Years

Spiegel, Rebecca; Merius, Heidy

doi:10.3389/fneur.2020.00322

Cited by 9 publications

(11 citation statements)

References 36 publications

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Section: Appropriate Anti-seizure Medications During the Reproductive Agementioning

confidence: 99%

“…Ideally, the most appropriate ASM regimen should be selected prior to the woman's first menses or soon after [6]. The appropriate selection includes choosing a suitable ASM for the patient's seizure type and avoiding ASMs with teratogenic potential and cognitive side effects [6,28]. The optimal regimen also entails administering ASMs at the lowest effective doses and avoiding polytherapy, when possible [6].…”

Section: Appropriate Anti-seizure Medications During the Reproductive Agementioning

confidence: 99%

“…Lastly, WWE who are sexually active should receive folic acid supplementation to improve cognition in children exposed to ASMs in utero [6]. The protective effect of folic acid on neural tube defects has not been well established in children exposed to ASMs but has been proven to reduce neural tube defects in the general population and is, thus, recommended for all WWE in the reproductive age group [6,9]. If there is a family history of neural tube defects, carbamazepine and valproic acid should be avoided, as these medications can increase the risk of neural tube defects [35].…”

Section: Appropriate Anti-seizure Medications During the Reproductive Agementioning

confidence: 99%

“…Furthermore, in premenopausal WWE, it is important to choose an ASM that is both effective for the patient's seizure type and is associated with the lowest risk of teratogenicity and cognitive impairment of a potential offspring. In addition, avoiding polypharmacy when possible and choosing the lowest effective ASM dosage prior to pregnancy have also been proven to be effective in optimizing the health of the offspring [6][7][8]. Lastly, given that the neural tube forms during the first four weeks of gestation, when the woman is not aware of her pregnancy, WWE with childbearing potential are advised to take daily folic acid supplementation during their reproductive years to reduce the risk of neural tube defects and to enhance cognitive development in the offspring [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Special Considerations in the Management of Women with Epilepsy in Reproductive Years

Parekh

Kravets

Spiegel

2022

JPM

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Anti-seizure medications (ASMs) fail to prevent seizure recurrence in more than 30% of patients with epilepsy. The treatment is more difficult in premenopausal women with epilepsy (WWE) because changes in plasma estrogen and progesterone concentrations during the menstrual cycle often affect seizure frequency and intensity. Interactions between enzyme-inducin ASMs and hormonal contraceptives can lead to both a loss of seizure control and failure of contraception. Significant changes in the function of the liver and kidneys during pregnancy can accelerate metabolism and elimination of ASMs, causing breakthrough seizures. In addition, the teratogenic, cognitive, and psychological effects of ASMs on potential offspring have to be considered when choosing the best ASM regimen. Therefore, aspecialized approach is necessary for the treatment of premenopausal WWE.

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Section: Appropriate Anti-seizure Medications During the Reproductive Agementioning

confidence: 99%

Section: Appropriate Anti-seizure Medications During the Reproductive Agementioning

confidence: 99%

Section: Appropriate Anti-seizure Medications During the Reproductive Agementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Special Considerations in the Management of Women with Epilepsy in Reproductive Years

Parekh

Kravets

Spiegel

2022

JPM

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“…Fertile years of pregnancy can be challenging for this population. It has been shown that children born to these women are exposed to an increased risk of major congenital anomalies, lower intelligence quotient scores, and neurodevelopmental disorders when the mother is undergoing anticonvulsant therapy medications (Spiegel & Merius 2020).…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Humor Training on Happiness and Life Satisfaction of Female Patients With Epilepsy

shirvan

Koolaee

2021

JCCNC

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Background: Women with epilepsy face many physical and psychological problems due to their illness. Epilepsy affects women’s motherhood, parenting role, and quality of life. Thus, in addition to medical interventions, their recovery programs should also cover psychological therapies. Accordingly, this study aimed to examine the effectiveness of humor training on happiness and life satisfaction of female patients with epilepsy. Methods: This study was conducted using a quasi-experimental method with a pretest-posttest design and control group. The research population included all female patients who were members of the Iranian Epilepsy Association, Tehran, in 2020. The subjects were selected using convenience sampling. To this end, 30 women who met the inclusion criteria were randomly assigned into the intervention and control groups. The intervention group attended eight 2-hour humor training sessions and the control group did not receive any training. The Oxford Happiness Questionnaire and the Satisfaction with Life Scale (SWLS) were completed by the subjects before and after the intervention. The collected data were analyzed by one-way Analysis of Covariance (ANCOVA) using SPSS software (version 24). Results: According to the findings, the patients who received humor training reported significantly higher levels of happiness and life satisfaction compared to the control group. There was a significant difference between the pre-test and post-test mean scores of happiness (pre-test: 38.20±3.59; post-test: 45.27±4.18) (F=26.37; P=0.001) and also, there was a significant difference between the mean scores of pre-test and post-test of life satisfaction (pre-test: 13.01±6.16; post-test: 18.67±5.70) (F=30.07; P=0.001) in the intervention group. This difference was not significant in the control group (p>0.05). Conclusion: Humor training increased happiness and life satisfaction among women with epilepsy. This low-cost and easy-to-implement training is recommended to be used by psychologists and psychiatric nurses as a non-pharmacologic alternative along with other treatment options.

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Folic acid supplementation in women of childbearing age with epilepsy: No association with type or number of antiepileptic drugs

Gandelman‐Marton,

Theitler

2023

Birth Defects Research

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BackgroundFor over two decades, a daily folic acid (FA) supplementation has been recommended for women of childbearing age with epilepsy. This recommendation is based on evidence that FA administration before conception and during pregnancy can decrease the risk of fetal malformations in the general population, improve cognitive development, and reduce the risk of autistic traits in children exposed in utero to antiepileptic drugs (AEDs).ObjectiveThe aim of this study was to evaluate FA supplementation rate in nonpregnant women of childbearing age with epilepsy and its relation to AED type and number.MethodsWe retrospectively reviewed the computerized database and the medical records of all the women who had a first visit to our outpatient epilepsy clinic (Shamir‐Assaf Harofeh Medical Center, Zerifin, Israel) during a 10‐year period (2012–2021).ResultsOnly 61 (22%) of 282 nonpregnant women of childbearing age with epilepsy treated with AEDs received FA supplementation. Ninety‐two (33%) of the women were treated with AED polytherapy, and 41 (15%) received valproic acid in monotherapy or polytherapy. FA supplementation rate was higher in women aged ≤40 versus >40 (25% vs. 8.5%) (p = .004). No correlation was found between FA supplementation and AED type or number.ConclusionsFA supplementation rate was low and was unaffected by AED treatment. Patient and physician‐targeted interventions should be implemented to increase FA prescription and patient adherence.

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Principles of Epilepsy Management for Women in Their Reproductive Years

Cited by 9 publications

References 36 publications

Special Considerations in the Management of Women with Epilepsy in Reproductive Years

Special Considerations in the Management of Women with Epilepsy in Reproductive Years

The Effectiveness of Humor Training on Happiness and Life Satisfaction of Female Patients With Epilepsy

Folic acid supplementation in women of childbearing age with epilepsy: No association with type or number of antiepileptic drugs

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