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Updated: Oct 6, 2025

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Published on: September 1, 2023
Special Considerations in the Management of Women with Epilepsy in Reproductive Years
Krishna Parekh1, Hannah Debra Kravets1, Rebecca Spiegel1
1Department of Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
Abstract:
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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