[Comprehensive management for women with epilepsy]

Medical treatment of epilepsy is quite different for women than for men. It is known that estrogen facilitates while progesterone inhibits the generation of epileptic seizures. Due to the direct neuronal effects of estrogen, progesterone, and their metabolites, as well as the cyclic nature of sex hormone release, women are particularly susceptible to the effects of these hormones on seizure frequency and severity. Antiepileptic drugs (AEDs) may result in reproductive endocrine disorders, inhibition of sexuality, decrease in oral contraceptive effects, or congenital malformations. Results of a systematic literature review suggest that the overall incidence of the congenital malformations in children born to women with epilepsy is approximately three times that of healthy women. The risk is elevated in all patients receiving AED monotherapy and further elevated in those receiving AED polytherapy compared to women without epilepsy. Studies have shown that many of these risks can be minimized with appropriate treatment and preconception counseling. The present review article summarizes the comprehensive management of women with epilepsy from a bio-psycho-socio-ethical point of view.