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Women, Epilepsy, and Sexuality

New knowledge, new drugs open new doors for people with seizure disorders.
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Readdressing Reproductive Health continued...

"Since progesterone levels drop during menses, that may render a woman more susceptible to a seizure during that time period," she explains.

In Boston, Andrew Herzog, MD, director of the Neuroendocrine Unit at Beth Israel Deaconess Medical Center, is working on a large National Institutes of Health-sponsored study designed to provide new answers. While final answers are still years away, preliminary evidence suggests that giving progesterone during menstruation may help to assuage hormone-related seizures.

But not all the news is good: Other studies have shown that some older epilepsy drugs, particularly valproate (sold under the brand names Depakote, Depakene, and Epivil), can interfere with ovulation, Pack tells WebMD. And that, in turn, can lead to infertility and long-term health problems, including high cholesterol levels, certain female-specific cancers, and diabetes, she says.

And the list doesn't end there: "Women taking valproate also report excess weight gain and hair growth," Pack says. Also, a recent study at Columbia University showed that women who took valproate at any time during the past three months were at increased risk of developing cysts in their ovaries.

"The bottom line," Pack says, "is that I tend not to prescribe valproate as a first-line drug for most women with epilepsy who are in their reproductive years. That's not to say that valproate is not a good drug, but with so many other choices available, [for these women] I tend to pick something that won't have these side effects."

While a variety of factors need to be considered when choosing a medication to control seizures in women with epilepsy, Pack says many neurologists have indicated a preference for Lamictal due to its relatively safe side-effect profile.

According to the Epilepsy Foundation, Lamictal neither increases the breakdown of female hormones nor interferes with the effectiveness of hormonal birth control, unlike other seizure medications.

But for women with epilepsy who also suffer from migraine headaches, Topamax is usually considered the drug of choice because of its headache-relieving properties, Pack says.

Epilepsy and Birth Control

Given the complex interactions between hormones and seizures, it's not surprising that certain seizure medications can prevent birth control pills from working effectively, experts note. These medications can affect a system in the liver that breaks down medications. According to the Epilepsy Foundation, the so-called "liver enzyme-inducing" drugs -- Tegretol, Dilantin, phenobarbital (Luminal), Mysoline, and Topamax -- increase the breakdown of contraceptive hormones in the body, making them less effective in preventing pregnancy. Valproate and Felbatol, on the other hand, can actually raise hormonal levels, which may require an adjustment in dose.

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