Issues for mature women with epilepsy

Specific concerns regarding mature women with epilepsy (WWE), specifically epilepsy-associated issues during perimenopause, menopause, and postmenopause, have been emerging in the epilepsy community. This chapter presents evidence that for WWE, seizure frequency may increase during perimenopause and decrease at postmenopause, especially if a catamenial epilepsy pattern was present during the reproductive years. This finding implies that, as in other age groups, a subset of mature WWE are particularly susceptible to endogenous reproductive hormonal changes. An adverse effect on seizure frequency with the use of hormone replacement therapy (HRT) during postmenopause for WWE was reported in surveys, and a dose-related association between standard HRT and increased seizures was later borne out in a double-blind, placebo-controlled, randomized clinical trial. Management of symptomatic postmenopausal WWE using estrogenic and progestogenic compounds that are less likely to promote seizures is discussed. WWE are at risk for premature ovarian failure and for menopause at a younger age than the general population. This appears to be related to epilepsy severity in terms of seizure frequency and is likely a consequence of adverse effects of seizures and interictal activity on the hypothalamo-pituitary-gonadal axis. The decline in antiepileptic drug (AED) clearance, as well as alterations in gastric functioning and decreasing albumin levels, with maturity can affect AED use in the aging population; therefore, mature individuals with epilepsy need to be monitored carefully for toxicity and for increasing AED levels that could eventually cause toxicity. Information about gender differences for AED use in the mature population is scant.