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Session B (Dugan)
Session B (Dugan)
FACES
2014 Annual Epilepsy Conference
April 27, 2014
Patricia Dugan, MD
Assistant Professor of Neurology
NYU Langone Medical Center
Comprehensive Epilepsy Center
Beyond Seizure Control:
Key Issues That Affect Women Taking AEDs
Pregabaline Lacosamide
Manifestations of Bone Disease
• Osteopenia/Osteoporosis
– AEDs reported as a secondary cause
– Increased rates at multiple sites including hip and
lumbar spine
• Osteomalacia
– Increased osteoid or unmineralized bone
– Most studies in institutionalized persons
• Confounded by poor diet, inadequate sunlight, limited
exercise
• Carbamazepine
– Associated with bone loss and fracture (Hoikka et al., 1984; Verrotti et al.,
2000)
• Valproate
– Associated with bone loss (Sheth et al., 1995; Sato et al., 2001)
• Lamotrigine
– Not associated with bone loss (Pack et al, 2005)
• Limited information on new drugs
• More severe with polytherapy and prolonged use and
institutionalization (Bogliun et al., 1986; Gough et al., 1986; Chung et al., 1994)
Sexual Dysfunction and Hormones in
Women With Epilepsy
• Women ages 18 to 40, cycling, at least 4 years post-
menarche and taking a single AED
– Sexual dysfunction more prevalent in women receiving
enzyme-inducing AEDs than in controls (P<.05)
• Deficits in sexual desire correlated with reductions in
androgens
• Deficits in sexual arousal correlated with reductions in
estrogen
• Sexual dysfunction also associated with comorbid
depression
Wallace H, Shorvon S, Tallis R. Age-specific incidence and prevalence rates of treated epilepsy in an unselected population of 2,052,922 and
age-specific fertility rates in women with epilepsy. Lancet 1998; 352: 1970-73.
Do WWE choose to have
children less often?
Crawford P and Hudson S. Understanding the information needs of women with epilepsy at different lifestages: results
of the ‘Ideal World’ survey. Seizure 2003; 12: 502-7.
Does the marriage rate in WWE
affect the fertility rate?
• Individuals with epilepsy are less likely to
marry.
•The fertility deficit persists when analysis is
restricted to married individuals only.
•Individuals with epilepsy are less likely to
choose to have children
Schupf N and Ottoman R. Likelihood of pregnancy in individuals with idiopathic/cryptogenic epilepsy: social and biological factors.
Epilepsia 1994; 35(4): 750-56.
Does polytherapy worsen infertility?
• A prospective cohort of WWE enrolled in the Kerala
(India) Registry of Epilepsy and Pregnancy (1998–2007)
in the preconception stage.
Harden, C. Sexuality in women with epilepsy. Epilepsy and Behavior 2005; Suppl 2:S2-6.
Reproductive dysfunction
• Common among WWE and manifested as:
– menstrual disorder, hirsutism, infertility
and/or male
distribution of body
hair
• It’s not known how well the new AED will work or if it’ll have side
effects
Dysmorphic
Yes Yes Yes Yes
syndrome
Risks of Seizures
• Fetal Risks
– Intracranial Hemorrhage
– Suppression of Fetal HR
– Miscarriages
Abruptio Placenta:
Minor blunt trauma 1-5%
Major blunt trauma 20-50%
• Maternal Risks
– Death rate during pregnancy in women with epilepsy
increased X10, primarily due to seizures in UK study
– Trauma leading cause of non-obstetrical cause of
death in pregnant women with epilepsy
So what about... ? ?
• PREGNANCY:
– Most WWE who become pregnant will have a healthy pregnancy and healthy
baby
– Good care before & during pregnancy is key
– Special attention is warranted to keep the women and their children safe, and
to ensure the optimal outcome.
• SUPPLEMENTATION:
– Folic acid in women of childbearing potential
– Calcium and vitamin D for all ages
– Vitamin K during the last month of gestation
• Most WWE have normal pregnancies, but appear to be at risk for problems during
pregnancy (e.g., seizures, change in medications, depression, c-sections) and adverse
outcomes in their children (e.g., lower birth weight, thinking, or behavioral problems).
• Purpose: to establish the risk and determine the factors which contribute to those
risks.
• Researchers want to know if epilepsy or the medicines that mothers-to-be must take
to control seizures have a negative impact on the outcome of their pregnancy (e.g.,
OB complications, depression, seizures, or effects on their child).
• Determine impact of different AEDs have on the mother’s epilepsy during pregnancy
(CBZ, LTG, LEV)
www.moneadstudy.org/
Thank you for your attention!
Many thanks to Dr. Jackie French and Dr. Blanca Vazquez for generously loaning their slides!