Epilepsy and Women

with Lorri Lobeck, M.D., General Neurologist, Advanced Healthcare

Posted: Oct. 1, 2005

Approximately one-half of the two million Americans who have epilepsy are girls and women, according to Lorri Lobeck, M.D., a general neurologist with Advanced Healthcare. Every year about 180,000 new cases of epilepsy are diagnosed in the United States. Although the disorder most often occurs in children and the elderly, it also can develop between the ages of 20 and 50. Dr. Lobeck says epileptic seizures are second only to headaches as the most common neurological disorder seen by physicians and encourages women with seizures to seek medical care and advice immediately.

Lorri Lobeck, M.D., General Neurologist, Advanced Healthcare "If side effects are issues for a woman with epilepsy, it’s important she talk to her healthcare provider about an alternative drug choice."

Repeated episodes of seizures are caused by a disturbance in the brain's electrical system. There are several types of seizure disorders — partial seizures and generalized seizures.

“Partial seizures start in one area of the brain and may cause some alteration of consciousness or focal symptoms. Generalized seizures result in loss of consciousness and often shaking of the arms and legs,” she said. “The length and severity of seizures varies from a few seconds to several minutes, and includes symptoms ranging from blank stares and lip smacking to extreme jerking of the arms and legs.”

If someone has a seizure and doesn’t regain consciousness after a while and then has another clinical seizure, that’s called status epilepticus, she explained. “That’s a dangerous situation because these people often have repeated seizures and require ICU care and medication.”

What causes epilepsy and seizures?
There are several possible causes for epilepsy, according to Dr. Lobeck. “These include infections, head injuries, brain tumors, brain injuries at birth, and inherited disease. But many times the cause of epilepsy in an individual is never identified.”

Dr. Lobeck says women diagnosed with epilepsy face unique health issues that include reproductive problems, osteoporosis, weight gain, and sexual dysfunction.

“Many women with epilepsy will notice increased seizure frequency as a result of their menstrual period. Estrogen levels may be the cause, while progesterone levels may actually be protective. Some women will experience seizures just before their periods because of changing hormone levels,” she said.

Risks associated with epilepsy
“Many of the older anticonvulsant medications have interacted with oral contraceptives, making them less effective. Women with epilepsy should be aware of these interactions to avoid pregnancy. We have newer medications that are much better in controlling seizures without interacting with the birth control pill,” she said.

Another issue of concern is the fact that children born to women with epilepsy have a slightly higher risk of fetal malformation. “For the general population that’s a two to three percent risk. For women with epilepsy, that risk goes up to four to six percent. That’s why it’s important for them to meet with a neurologist well before they are planning for a family,” Dr. Lobeck said. “We need to talk about the best medications for them and how to manage their pregnancies. We need to prescribe medications that will control their seizures and at the same time prevent complications for the baby.”

Bone density is another issue. “Many of the older anticonvulsant medications were causing bone density loss,” she said. “So in recent years we’ve seen a shift to newer medications that aren’t instrumental in causing osteoporosis.”

Women who experience weight gain while taking certain anticonvulsant drugs should understand that excessive weight could lead to other health risks. These include high blood pressure, heart disease, diabetes, and cancer.

If a seizure medication is causing problems for a patient, it is important to address those issues rather than a patient deciding to stop medication, which may result in seizures. Anticonvulsants are also the potential cause of other problems such as gum swelling, unwanted growth of facial hair, and scalp hair loss.

“If side effects are issues for a woman with epilepsy, it’s important she talk to her healthcare provider about an alternative drug choice,” she said.

Since epilepsy is a brain disorder, Dr. Lobeck says it’s not surprising that some epileptic women also experience sexual dysfunction. Some symptoms of sexual dysfunction may be manifested by pain during sexual intercourse, vaginal muscle spasms during sexual intercourse, inability to achieve orgasm, or substantially decreased or increased interest in sex. These issues also should be addressed with the woman’s physician.

Lorri Lobeck, M.D.
Advanced Healthcare
Good Hope Clinic
3003 West Good Hope Rd.
Milwaukee, Wis.
414-352-3100

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