1
|
Hophing L, Kyriakopoulos P, Bui E. Sex and gender differences in epilepsy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:235-276. [PMID: 36038205 DOI: 10.1016/bs.irn.2022.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex and gender differences in epilepsy are important influencing factors in epilepsy care. In epilepsy, the hormonal differences between the sexes are important as they impact specific treatment considerations for patients at various life stages particularly during early adulthood with establishment of the menstrual cycle, pregnancy, perimenopause and menopause. Choice of antiseizure medication may have direct consequences on hormonal cycles, hormonal contraception, pregnancy and fetal risk of major congenital malformation. Conversely hormones whether intrinsic or extrinsically administered may have direct impact on antiseizure medications and seizure control. This chapter explores these important influences on the management of persons with epilepsy.
Collapse
Affiliation(s)
- Lauren Hophing
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada
| | | | - Esther Bui
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada.
| |
Collapse
|
2
|
Mann C, Süß A, von Podewils F, Zahnert F, Langenbruch L, Bierhansl L, Menzler K, Schulz J, Gaida B, Rosenow F, Strzelczyk A. Gender differences in concerns about planning to have children and child-rearing among patients with epilepsy: A prospective, multicenter study with 477 patients from Germany. Epilepsy Behav 2022; 129:108650. [PMID: 35290934 DOI: 10.1016/j.yebeh.2022.108650] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the concerns and worries about planning to have children and being a parent as a person with epilepsy and investigate gender differences in these perceptions. METHODS The Epi2020 study was a large multicenter study focusing on different healthcare aspects of adult patients with epilepsy in Germany. In addition to basic clinical and demographic characteristics, patients were asked to answer a questionnaire regarding their plan to have children, if they had children, and concerns about their children's health. Data were analyzed to detect differences between men and women with epilepsy according to age group. RESULTS In total, 477 patients with epilepsy with a mean age of 40.5 years (SD = 15.5, range: 18-83 years) participated in this study; 280 (58.7%) were female and 197 (41.3%) were male. Both women and men frequently reported concerns and worries about having children: In the age group below 45 years of age, 72.5% of women and 58.2% of men described being worried to some extent that their children may also suffer from epilepsy (p = .006). Furthermore, 67.3% of women and 54.2% of men below the age of 45 years reported being worried that their children may be disabled (p = .003). Women were more likely to have family members who are reluctant to support their desire to have children (p = .048). CONCLUSION Women with epilepsy of childbearing age are significantly more likely to report major concerns that their children might be disabled or also have epilepsy than men with epilepsy and, therefore, express more concerns about choosing to have a child. However, men also report frequent concerns and worries, and this should be addressed not only on request but should be included in the provision of general information on epilepsy.
Collapse
Affiliation(s)
- Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Annika Süß
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix von Podewils
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Felix Zahnert
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University, Münster, Germany; Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
| | - Laura Bierhansl
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University, Münster, Germany
| | - Katja Menzler
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Juliane Schulz
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Bernadette Gaida
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
3
|
Scime NV, Lee S, Jain M, Metcalfe A, Chaput KH. A Scoping Review of Breastfeeding in Women with Chronic Diseases. Breastfeed Med 2021; 16:851-862. [PMID: 34319788 DOI: 10.1089/bfm.2021.0129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Approximately 10-20% of mothers have a chronic disease. Studies on breastfeeding in women with chronic disease span multiple disciplines, and these have not been collated to synthesize knowledge and identify gaps. The objective of this review was to summarize published literature on breastfeeding in women with chronic disease. Methods: We conducted a scoping review of original research and systematic reviews identified in Medline, EMBASE, and CINAHL (1990-2019) and by hand searching on women with chronic diseases reporting on at least one breastfeeding-related topic. Conference abstracts, case-studies, and studies on pregnancy-induced conditions or lactation pharmacology were excluded. Content analysis and narrative synthesis were used to analyze findings. Results: We identified 128 articles that were predominantly quantitative (80.5%), conducted in Europe or North America (65.6%), analyzed sample sizes of <200 (57.0%), and published from 2010 onward (68.8%). Diabetes (42.2%), multiple sclerosis (MS; 19.5%), and epilepsy (13.3%) were the most common diseases studied. Breastfeeding was a primary focus in approximately half (53.1%) of the articles, though definitions were infrequently reported (32.8%). The most-studied topics were breastfeeding duration/exclusivity (55.7%), reasons for feeding behavior (19.1%), and knowledge and attitudes about breastfeeding (18.3%). Less studied topics (<10% of articles each) included milk expression behaviors, breastfeeding difficulties, and feeding supports. Conclusions: Existing literature focuses primarily on diabetes or MS, and breastfeeding behaviors and outcomes. Further research examining a broader range of chronic diseases, with large sample sizes, and sufficient breastfeeding measurement detail can improve our understanding of breastfeeding disparities in this population.
Collapse
Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sangmin Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mandakini Jain
- Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kathleen H Chaput
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
4
|
Huber-Mollema Y, Oort FJ, Lindhout D, Rodenburg R. Maternal epilepsy and behavioral development of the child: Family factors do matter. Epilepsy Behav 2019; 94:222-232. [PMID: 30974351 DOI: 10.1016/j.yebeh.2019.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of the study was to examine whether mothers with epilepsy experience family problems and to investigate the possible mediating role of distinct family factors in the relationship between maternal epilepsy and child behavioral problems, in which it is also investigated whether more proximal family factors mediate the more distal family factors. METHODS In an observational study, with children identified from the European Registry of Antiepileptic Drugs and Pregnancy database in the Netherlands (EURAP-NL), parents completed questionnaires on maternal epilepsy, family factors (proximal, distal, contextual, global), and child behavior. Hierarchical multilevel regression analyses were performed to examine the relative contribution of epilepsy-related and family factors on child internalizing and externalizing problems. RESULTS Between January 2015 and March 2018, the questionnaires were completed for 175 children. Mothers with epilepsy showed significantly more parenting stress and problems with parenting than mothers from the general population. Family factors were significantly associated with child behavioral problems. For internalizing problems, maternal epilepsy, global, contextual, and distal family factors were each found to have significant added value. Distal family factors contributed most to internalizing problems and showed a mediating role for epilepsy-related factors and previous added family factors in the model. Global, contextual, distal, and proximal factors were all found to be significant contributors to externalizing problems, with the factor most proximal to the child (quality of parent-child interaction) showing the largest effect. DISCUSSION Including family factors in research regarding children of mothers with epilepsy is important as they can have a contribution additional to the teratogenic risks of prenatal exposure to antiepileptic drugs (AEDs). Family factors, in particular distal and proximal family factors, can weaken or strengthen child development and may provide starting points for interventions.
Collapse
Affiliation(s)
- Yfke Huber-Mollema
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Frans J Oort
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Dick Lindhout
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Department of Genetics, University Medical Center Utrecht, the Netherlands
| | - Roos Rodenburg
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, the Netherlands.
| |
Collapse
|
5
|
Huber-Mollema Y, van Iterson L, Sander JW, Oort FJ, Lindhout D, Rodenburg R. Exposure to antiepileptic drugs in pregnancy: The need for a family factor framework. Epilepsy Behav 2018; 86:187-192. [PMID: 30030084 DOI: 10.1016/j.yebeh.2018.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Children exposed to antiepileptic drugs (AEDs) in utero are at risk for developmental problems. Maternal epilepsy, its impact on the family system, and other family factors may also contribute. We reviewed the possible associations between family factors and developmental outcome in children who had been exposed to AED during pregnancy. METHODS We conducted a narrative review and searched MEDLINE, Embase, Google Scholar, and PsycINFO on the following terms: in utero exposure, pregnancy outcome, and AEDs. A family factor framework (the ABCX model) served as the basis to review distinct family factors in children who were exposed to AEDs in pregnancy. RESULTS Few studies have investigated these factors. Mothers with epilepsy have problems caring for themselves and for the child and experience more parenting stress. There is a paucity of studies of the possible impact of family factors on the neurocognitive and behavioral development of children of mothers with epilepsy. DISCUSSION Further work is required to ascertain which family factors are associated with child development in addition to the effects of AED exposure and their potential interaction. As epilepsy may have considerable impact on intrafamily factors and as children are especially vulnerable to such effects, study designs incorporating family factors should be encouraged.
Collapse
Affiliation(s)
- Yfke Huber-Mollema
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Loretta van Iterson
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; NIHR University College London Hospitals, Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Frans J Oort
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Dick Lindhout
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Department of Genetics, University Medical Center Utrecht, the Netherlands
| | - Roos Rodenburg
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, the Netherlands.
| |
Collapse
|
6
|
H. Bjørk M, Veiby G, A. Engelsen B, Gilhus NE. Depression and anxiety during pregnancy and the postpartum period in women with epilepsy: A review of frequency, risks and recommendations for treatment. Seizure 2015; 28:39-45. [DOI: 10.1016/j.seizure.2015.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022] Open
|
7
|
Epilepsy and recommendations for breastfeeding. Seizure 2015; 28:57-65. [DOI: 10.1016/j.seizure.2015.02.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/27/2015] [Accepted: 02/10/2015] [Indexed: 02/08/2023] Open
|
8
|
Saramma PP, Sarma PS, Thomas SV. Effect of a self-instructional module on the child rearing knowledge and practice of women with epilepsy. Seizure 2014; 23:424-8. [PMID: 24647345 DOI: 10.1016/j.seizure.2014.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 01/16/2023] Open
Abstract
UNLABELLED Women with epilepsy (WWE) have poorer knowledge and skill in child rearing than women without epilepsy. PURPOSE To evaluate the effect of a self-instructional module (SIM) on the child rearing knowledge (CRK) and practice (CRP) of WWE and developmental outcome of their babies. METHODS One hundred women in first trimester of pregnancy that were enrolled in to the Kerala Registry of Epilepsy and Pregnancy and consenting to participate were given a self instructional module (SIM) or a comparator booklet by random concealed allocation. Their child rearing knowledge (CRK) was assessed by a standardized protocol at entry (first trimester) and at 3-4 months postpartum. Their child rearing practice (CRP) was evaluated in third postpartum month. The developmental outcome of babies was assessed at 1 year of age as per registry protocol. RESULTS Eighty eight women completed this 1 year study. The CRK score was significantly higher (p=.034) for the intervention group (32.91±5) when compared to the comparator group (30.61±5) However, a corresponding improvement in CRP score was not observed for the former. Developmental outcome of 68 babies showed a positive weak correlation between CRP and developmental quotient both mental and motor. The intervention group demonstrated significant increase in their CRK. Nevertheless the results did not indicate a significant improvement in the CRP. CONCLUSION The SIM improved the CRK of WWE. Nevertheless, the child rearing practices did not show corresponding improvement.
Collapse
Affiliation(s)
- P P Saramma
- Kerala Registry of Epilepsy and Pregnancy, Comprehensive Epilepsy Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India
| | - P S Sarma
- Kerala Registry of Epilepsy and Pregnancy, Comprehensive Epilepsy Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India
| | - Sanjeev V Thomas
- Kerala Registry of Epilepsy and Pregnancy, Comprehensive Epilepsy Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India.
| |
Collapse
|
9
|
McGrath A, Sharpe L, Lah S, Parratt K. Pregnancy-related knowledge and information needs of women with epilepsy: a systematic review. Epilepsy Behav 2014; 31:246-55. [PMID: 24210460 DOI: 10.1016/j.yebeh.2013.09.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/23/2013] [Accepted: 09/29/2013] [Indexed: 10/26/2022]
Abstract
For women with epilepsy (WWE), pregnancy is complicated by considerations such as the potential teratogenicity of antiepileptic drugs (AEDs) versus the risks of having seizures during pregnancy. However, qualitative research suggests that many WWE remain uninformed about the risks associated with epilepsy and pregnancy and may, therefore, be making uninformed decisions about their families. The objectives of this review were to determine the level of patient knowledge, their informational needs, and whether these needs concerning pregnancy and childbirth issues are met among WWE. Electronic databases searched were PsycINFO, MEDLINE, Embase, CINAHL, and Web of Science. Studies were included if they used quantitative methods to survey WWE aged 16years or older about their knowledge, access to information, or informational needs specifically regarding epilepsy and pregnancy. Twelve studies were identified and assessed for research standards using the Quality Index. Overall Quality Index score was only 7.1 out of 14, indicating significant design limitations of many included studies, including highly selective sampling methods and the use of unvalidated outcome measures. There was a paucity of studies investigating specific areas of women's knowledge and information needs. Overall, WWE reported adequate awareness, but limited knowledge, of key issues regarding pregnancy and childbirth. Across studies, many women reported not receiving information about these issues. Evidence suggested that many WWE wanted to receive more information - particularly about the risks of AEDs for their offspring - well in advance of choosing an AED or planning pregnancy. Women aged under 35years wanted the most information. Preconception counseling received by many WWE appears insufficient, risking uninformed decision-making about pregnancy. Further research is needed to investigate the barriers that WWE face in accessing, receiving, and retaining appropriate information.
Collapse
Affiliation(s)
- Amanda McGrath
- The School of Psychology A18, The University of Sydney, NSW 2006, Australia
| | - Louise Sharpe
- The School of Psychology A18, The University of Sydney, NSW 2006, Australia.
| | - Suncica Lah
- The School of Psychology A18, The University of Sydney, NSW 2006, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, NSW 2109, Australia
| | - Kaitlyn Parratt
- Comprehensive Epilepsy Service, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
| |
Collapse
|
10
|
Weckesser A, Denny E. Women living with epilepsy, experiences of pregnancy and reproductive health: a review of the literature. Seizure 2012. [PMID: 23182977 DOI: 10.1016/j.seizure.2012.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE This study aimed to investigate the experiences of pregnancy in women living with epilepsy through a review and synthesis of existing literature. METHODS A comprehensive search of the literature was conducted in medical and social science databases to identify qualitative research, and questionnaires that included open-ended questions, which reported on the impact of epilepsy on the lives of pregnant women from preconception to post-delivery. The search was widened to include qualitative studies on pregnancy and issues of reproduction with women living with chronic illness that had at least one woman with epilepsy in the sample. The systematic search, carried out from April to June 2012, identified 17 publications that met the inclusion criteria, and 24 publications that did not. Qualitative results from these studies were categorised into: stage of pregnancy (preconception, pregnancy, and postnatal); case studies of patients' experiences; and the reproductive health experiences of women living with chronic illness. RESULTS One qualitative study was identified that directly investigated women's experiences of epilepsy during pregnancy. Many of the findings from the 16 remaining publications were found to be limited in generalisability due to small sample sizes and/or the poor quality of data. CONCLUSION Qualitative research on women's experiences of pregnancy whilst living with epilepsy is needed to address this critical gap in knowledge. This paper calls for improved preconception, pregnancy and postnatal supports and information for women living with this condition.
Collapse
Affiliation(s)
- Annalise Weckesser
- Birmingham City University, Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK.
| | | |
Collapse
|
11
|
|
12
|
Abstract
Epilepsy is a common neurological condition with gender-related management implications. Epilepsy and antiepileptic drug treatment affect aspects of contraception, fertility and pregnancy which are discussed in the article.
Collapse
Affiliation(s)
- S Weil
- Neurologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, München, Deutschland
| | | |
Collapse
|
13
|
Weil S, Deppe C, Noachtar S. The treatment of women with epilepsy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:787-93. [PMID: 21124696 DOI: 10.3238/arztebl.2010.0787] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 05/31/2010] [Indexed: 01/12/2023]
Abstract
BACKGROUND Women with epilepsy and their doctors are often unsure of the implications of the disease and the limitations it causes. There is a major need for counseling. METHODS Selective review of the literature as of November 2009. RESULTS Recommendations on pregnancy and childbearing for women with epilepsy can be found in the guidelines issued by the German Societies of Neurology and Epileptology and by the American Epilepsy Society. Only low-level evidence is available on other relevant questions, including contraception, the influence of hormones on epilepsy, and the influence of antiepileptic drugs on endocrine and bone metabolism, because of a lack of controlled studies. Polycystic ovarian syndrome is more commonly seen in women with epilepsy who take valproate. Antiepileptic drugs that induce CYP3a can diminish the efficacy of oral contraceptives; conversely, oral contraceptives can markedly lower the blood levels of antiepileptic drugs. According to the most recent studies, the risk of congenital malformations and spontaneous abortions is 1% to 2% in the normal population and 3% to 9% in the offspring of women with epilepsy who are taking antiepileptic drugs. Women with epilepsy who want to have children are currently advised to take folic acid prophylactically starting before conception and until the end of the first trimester. New mothers with epilepsy are advised to breastfeed their children. CONCLUSION Proper treatment and counseling of women with epilepsy, with due attention to aspects that are specific to women patients, can reduce the limitations to which they are subject in everyday life.
Collapse
Affiliation(s)
- Sabine Weil
- Klinikum der Universität München - Großhadern, München, Germany
| | | | | |
Collapse
|
14
|
Pennell PB, Thompson P. Gender-specific psychosocial impact of living with epilepsy. Epilepsy Behav 2009; 15 Suppl 1:S20-5. [PMID: 19303945 DOI: 10.1016/j.yebeh.2009.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 03/05/2009] [Indexed: 12/29/2022]
Abstract
Although many psychosocial issues affect all people living with epilepsy, certain issues either are specific to one gender or have a different prevalence or significance between men and women with epilepsy. Most studies suggest that the incidence of epilepsy is slightly higher in males with epilepsy. Sexual dysfunction is common among men and women with epilepsy and has been related to epilepsy type and treatment. Women living with epilepsy are often prone to increased seizure frequency at certain phases of their menstrual cycles. Hormone replacement therapy in postmenopausal women may worsen seizures. Treatment during pregnancy is often a precarious balancing act between the teratogenic risks of AEDs and the maintenance of maternal seizure control. However, pregnancy registries and other prospective studies have given us invaluable information on how to optimize treatment regimens as well as information about safety of breastfeeding. These gender-specific factors should be a key consideration when counseling and treating patients with epilepsy.
Collapse
Affiliation(s)
- Page B Pennell
- Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Suite 6000, Atlanta, GA 30322, USA.
| | | |
Collapse
|
15
|
Heinrichs SC, Bromfield EB. Behavioral measures in animal studies: relevance to patients with epilepsy. Epilepsy Behav 2008; 12:612-21. [PMID: 18166501 DOI: 10.1016/j.yebeh.2007.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 11/23/2007] [Indexed: 11/27/2022]
Abstract
The relevance of behavioral endpoints in animal seizure models to clinical epilepsy is outlined and enhanced in the present review by linking specific preclinical dependent measures with a quality-of-life scale that serves as an index of the health and welfare of patients with epilepsy (Quality of Life in Epilepsy inventory). This preclinical-to-clinical translation is possible based on existing literature within at least three behavioral domains: (1) physical and motor actions, (2) affective and emotional responses to environmental challenge, and (3) social, sexual, and parental functions. Face valid commonalities in observable behaviors are emphasized with the goal of engaging basic and applied researchers in collaborative research projects to accelerate the pace of discovery in the behavioral phenotyping of epilepsy field.
Collapse
Affiliation(s)
- Stephen C Heinrichs
- VA Medical Center, Research 151-Neuropharmacology, 150 South Huntington Avenue, Boston, MA 02130, USA.
| | | |
Collapse
|