WebMD Medical Reference

Guide: Epilepsy and Women

Working in Partnership With Your Doctor for the Best Treatment

Reviewed by Brunilda Nazario, MD, April 24, 2008

If you have been diagnosed with epilepsy, you will have many questions. One of the first will probably be, "How can my epilepsy be treated?" There is no one answer to this question. That is because doctors have identified hundreds of different epilepsy syndromes, which involve many different types of seizures.

Your epilepsy may be inherited, or it may not. One study has found that some people with epilepsy have inherited an abnormally active version of a gene that makes them resistant to drugs. This may explain why some people have a hard time controlling their seizures with medication.

Even though they may look very different, seizures all start in the same place: your brain. They are caused by sudden changes in the way brain cells send electrical signals back and forth. But just because they start in the same place does not mean they can be treated in the same way. Your doctor will want to obtain an accurate diagnosis of the exact type of epilepsy that you have. Only then can your doctor create the treatment plan that is right for you.

Today, most epilepsy is treated with medication. Medication does not cure epilepsy, but it can often control it very well. About 80% of people with epilepsy today have their seizures controlled by medication at least some of the time. Of course, that means that 20% of people with epilepsy are not helped by medication. And others who do get some help from medication say that it doesn't help enough. Your doctor will work with you to select the right kind of medication for your type of seizures. If you find that the medication does not control your seizures, your doctor can then talk with you about other treatment options.

There are more drugs available today to control seizures than ever before. In fact, there are more than 20 different medications now on the market to treat epilepsy. Older medications which are still used to treat epilepsy include:

• Carbamazepine (Tegretol or Carbatrol)
• Divalproex (depakote, Depakote ER)
• Diazepam (Valium and similar tranquilizers)
• Ethosuximide (Zarontin)
• Phenytoin (Dilantin or Phenytek)
• Phenobarbital
• Primidone (Mysoline)
• Valproic acid (Depakene)

There are also some newer drugs used to treat epilepsy. Some of them are:

• Felbamate (Felbatol)
• Gabapentin (Neurontin)
• Lamotrigine (Lamictal)
• Pregabalin (Lyrica)
• Tiagabine (Gabitril)
• Topiramate (Topamax)
• Levetiracetam (Keppra)
• Zonisamide (Zonegran)

For more information about each drug, see "Epilepsy: Medications to Treat Seizures.""Epilepsy: Medications to Treat Seizures." Each of these drugs is slightly different. Some work well for some kinds of epilepsy and not for others. Each one also has its own side effects, like all drugs do. Besides your type of epilepsy, here are some other factors that can influence which drug might be right for you. You should discuss these with your doctor:

• Your age, gender, and other health issues.
• How the drugs work and possible side effects.
• Other medications you are taking.
• What kind of side effects you can live with.
• What you hope that the medication will do for you. For example, you might want a medication that helps you be more alert and concentrate better at work.

There are also specific questions that women with epilepsy should ask. For example:

• Is it safe to get pregnant while taking this drug?
• Could this drug interfere with my birth control?
• My seizures seem to be affected by my menstrual cycle. Will this drug help manage that?
• Could this drug increase my risk for osteoporosis?

One thing to keep in mind: Osteoporosis is a weakening of the bone structure that can occur as you get older. Some antiseizure drugs can increase the risk of developing osteoporosis if you take them for a long time. Because osteoporosis affects women far more than men, it is particularly important that you discuss this with your doctor when you plan your epilepsy treatment. You can then work together on ways to help protect your bone health. This would include eating a diet high in calcium, taking calcium and vitamin D supplements, getting lots of exercise, and avoiding alcohol and cigarettes.

Since all people are different, what worked for one person with the same kind of seizures you have may not work for you. You may find the right medicine right away, or you and your doctor may have to try two or more to find the one that is effective for you. When you first start taking a new drug, it's a good idea to keep track of any side effects you experience and tell your doctor about them. You may not be sure whether a symptom you experience -- like depression or weight gain -- is caused by the medication. If you're not sure, it's safest to tell your doctor about it anyway. Then you can both discuss the severity of the side effects and what to do about them.

Many people find that their epilepsy is controlled by just one medication. This is called monotherapy. Monotherapy has less risk of side effects than if you take more than one medication. It is also safer if you are planning to become pregnant. In some cases, though, one drug alone cannot control seizures. If this is true in your case, your doctor may want to try two or more drugs in combination -- polytherapy. Usually, you will start only one new medication at a time. This helps your doctor keep track of how well each one works, and whether there are any side effects.

What if medication cannot control your epilepsy? Doctors are learning more about treatment options that may help people with hard-to-control epilepsy. These include:

• Surgery. Doctors have performed surgery to help patients with epilepsy for many years. New surgical techniques have improved the outcomes. A study published in 2001 compared surgery to an additional year of treatment with antiepileptic drugs in people with temporal lobe epilepsy that was not well controlled with medications alone. It showed that 38% of patients who had surgery became seizure-free. Only 3% of the people who continued with medication alone became seizure-free. Depending on the type of seizure you have, if you have tried several medications without success, your doctor may recommend surgery.
• Vagus nerve stimulation (VNS). A vagus nerve stimulator works a lot like a pacemaker. It is surgically implanted in the chest, and delivers short bursts of energy to the brain. Scientists have found that it reduces seizures by about 40% to 50%. It does not work in everyone. If your doctor recommends VNS, you will probably still need to take medication, but you may be able to reduce your dose.

Other kinds of devices are also now being studied for people with hard-to-control epilepsy.

If you continue to have seizures while taking medication, there are several questions you can ask your doctor:

• Are there any new drugs for epilepsy that might work for me?
• Should I go to a special center for more testing?
• Do I have the kind of epilepsy that might be treated by surgery?
• Would my seizures respond to VNS therapy?

Having epilepsy can make it feel like you are not in complete control of your life. You can do your best to take back control by following these three steps: Work in partnership with your doctor. Keep track of information, such as when you have the seizures and the side effects of your medications. Ask questions. There are many resources available to help you manage your epilepsy and live a happy, healthy, productive life.

Next: Epilepsy Health Center

The Cleveland Clinic Health Information Center, "Treating Epilepsy." Epilepsy Foundation, "Bone Health a Concern for Some Women with Epilepsy." Epilepsy Foundation, "Epilepsy: an introduction." Epilepsy Foundation, "Finding the Right Medication." Epilepsy Foundation, "When Standard Treatment is Not Enough." National Institute of Neurological Disorders and Stroke, "Seizures and Epilepsy: Hope Through Research." Wiebe, S., et al, New England Journal of Medicine, Aug. 2, 2001; vol. 345: pp 311-318.