Any birth control that is safe for women, in general, is safe for women with epilepsy. However, having epilepsy -- and some treatments for the condition -- can make some forms of birth control less effective. Also, because anti-seizure medications for epilepsy can increase the risk of birth defects, it's important to plan pregnancy carefully.
To diagnose epilepsy, your doctor will take a detailed medical history (including a family history of seizures), gather information about your behavior before, during, and after the episode, and do a physical exam. Make sure someone who witnessed the seizure goes to the doctor with you.
An electroencephalogram (EEG) -- a brain wave study -- can reveal abnormal brain waves characteristic of epilepsy and sleep deprivation. Keeping someone awake for 24 hours increases the chances of finding abnormalities...
If you have epilepsy and take anti-seizure drugs, your birth control options could include hormones such as birth control pills or Depo-Provera injections, barrier methods like condoms or a diaphragm, or an intrauterine device (IUD). Natural family planning such as the rhythm method -- abstaining on your fertile days -- can also be used, although this method may not be as reliable as others. All of these methods are safe for you.
If you are taking anti-seizure medications, some of these drugs can interact with some hormonal types of birth control and make them less effective. If you understand these interactions, most of the time you can use the pill and other kinds of hormonal birth control effectively.
Different types of anti-seizure medications interact with hormonal birth control in different ways:
One group of anti-seizure drugs is known as "liver enzyme-inducing" drugs. They increase the rate at which the liver breaks down the contraceptive hormones that you get from birth control. This means that the contraception medication will leave your body faster. Liver enzyme-inducing drugs include carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal), phenytoin (Dilantin), phenobarbital (Luminal), primidone (Mysoline), eslicarbazepine acetate (Aptiom), and topiramate (Topamax). If you are taking one of these drugs, it can make your hormonal birth control less effective.
Two drugs -- valproate (Depakote) and felbamate (Felbatol) -- can even increase hormonal levels. If you are on one of these drugs, your doctor may need to adjust the dosage of your birth control so that you don't have too much of the contraceptive in your body.
Finally, there are "neutral" drugs which don't have any effect on hormone breakdown. Gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), clobazam, clonazepam, ethosuximide, Lyrica, sodium valproate, Zonegran, and tiagabine (Gabitril) will not interfere with your birth control.
Reliable Birth Control When You Have Epilepsy
If you are taking a liver enzyme-inducing drug, and you want to use hormonal birth control, you should talk to your neurologist and your gynecologist. It is a good idea to use a second method of birth control as a backup. Barrier methods, like condoms, diaphragms, and new-generation IUDs, are good options.
In the past, doctors have sometimes prescribed higher-dose birth control pills to make up for the rapid breakdown of the contraceptive drug. That may work, but there is no clear research to tell us one way or the other. "Doctors used to say that increasing the amount of the estrogen in the pill took care of this problem," says Jacqueline French, MD, professor of neurology at New York University's Langone Medical Center and co-director of Epilepsy Research and Epilepsy Clinical Trials at the NYU Comprehensive Epilepsy Center. "But we have no data to confirm that."