Epilepsy in women

Physicians should be aware of certain gender-related issues in the treatment of women with epilepsy. Although in the past reproduction was discouraged in women with epilepsy, more than 90% of the pregnancies in such patients currently have an uneventful outcome with appropriate management. Oral contraceptive agents are not contraindicated in women with epilepsy; however, the contraceptive failure rate increases fourfold if patients are being treated concurrently with enzyme-inducing antiepileptic drugs. In pregnant patients, free drug levels of carbamazepine, phenobarbital, phenytoin, and valproate may change because of alterations in protein binding, clearance, and possible absorption. The dosage should be adjusted if the patient's seizures are increasing. Women with epilepsy may have disease-related or treatment-related menstrual dysfunction, complications of pregnancy (slightly increased risk of toxemia and fetal loss), endocrine dysfunction, appearance changes (a general coarsening of facial features with long-term administration of antiepileptic agents), and psychosocial maladjustment. Some effects are drug specific. Although control of seizures remains the primary goal of treating women with epilepsy, the widening choice of antiepileptic drugs may facilitate optimal management of secondary and gender-specific complications.