Summary
Epilepsy, a chronic condition with a continuous predisposition to experiencing epileptic seizures, has consequences for the sufferer. These include a negative impact on the neurobiological, cognitive, psychological and social function of the affected individuals and their families. Pregnancy affects epilepsy control and predisposes the offspring to a range of risks.
Epilepsy
One per cent of the world population suffers from Epilepsy, a chronic condition with a continuous predisposition to experiencing epileptic seizures. It has consequences serious for the sufferer. There are over 50 million people affected, with a higher incidence in developing countries. Women and their pregnancies are particularly at risk.
Epilepsy can cause disability through memory alteration and language, mental retardation, defects in reasoning, attention and concentration deficit, motor and learning difficulties, drowsiness and behaviour problems. These disorders influence the quality of life of the person suffering from epilepsy and trigger low self-esteem, loss of independence, restrictions on activities of daily living and social interaction deficit. Epilepsy is associated with psychiatric comorbidities and behaviour such as depression, anxiety, aggressiveness, fear of not being accepted and ideation suicide.
Epilepsy in women
An epileptic woman, throughout her life, experiences various hormonal changes that influences the course of the disease. The hormones sex steroids, including estrogens and progesterone, have an influence on neuronal activity recurrently in each menstrual cycle. Up to a third of women can suffer hormone-dependent crises related to the menstrual cycle. Epilepsy affects all areas of the life of the sufferer including employment, marriage and parenthood.
Epilepsy and pregnancy
Pregnancy and epilepsy combined deserve special consideration because when they come together, they affect both the mother and the offspring. Antiepileptics drugs (AEDs) can have cause malformations in the fetus. During pregnancy, plasma concentration changes can alter the level of AEDs possibly triggering new seizures. Pregnant women with epilepsy also have a higher risk of neurological comorbidity with psychiatric illness, high economic cost, premature death, psychosocial dysfunction and reduction in quality of life.
There are more than a million women of fertile age with epilepsy in the world. In 1 out of 200 pregnancies, the mother can be epileptic. In Spain, it is estimated that among 400,000 epileptics, 62,800 are women of childbearing age (between 15 and 45 years old) who are likely to become pregnant. There is much disinformation in pregnant epileptics. There is a need to give the best advice possible without forgetting the psychosocial and economic aspects. Pre-conceptual counselling, antenatal care, administration of vitamin K and breastfeeding are all important areas to cover.
Conclusion
Women with epilepsy during reproductive age need pre-conceptual counselling. Effect of sex hormones, endocrine changes and reproductive function impacts treatment and prevention of seizures, fertility and quality of life. During pregnancy control seizures is achieved through careful monitoring of AEDs while keeping in mind the effects on offspring. These special considerations make epilepsy in women a unique condition.
Author: Professor Khalid Khan
