Living with Epilepsy
Certain issues emerge when a child with epilepsy matures into adulthood. Women and the elderly, in particular, may have concerns about epilepsy and their overall well being.
Driving, Sports, and Employment
Most people with epilepsy can control their seizures by taking antiepileptic drugs, and thus, are able to work and enjoy recreational activities much the same as others unaffected by the condition. However, because the possibility of breakthrough seizures exists, there are some limitations that people with epilepsy must adhere to for the safety of themselves and others.
The Female Factor
With each menstrual cycle, women of childbearing age experience fluctuations in levels of the hormones estrogen and progesterone. The primary function of these hormones relates to the reproductive system, but both have been found to affect certain brain cells. While estrogen may contribute to seizures, progesterone may inhibit them.
Some women with epilepsy have a greater number of seizures at mid-menstrual cycle (when ovulation occurs) and before their periods begin. These seizures, referred to as "catamenial epilepsy," are linked to hormonal changes, although the exact reason is not known. One possibility is that not enough progesterone is being produced during the latter part of the cycle. It may be helpful for women to mark on a calendar when their periods begin and when their seizures occur. A pattern of catamenial epilepsy should be discussed with a doctor, who may prescribe progesterone therapy to ease the menstrual-related seizures. As noted earlier, progesterone is a hormone that can have a inhibitive effect on seizures.
A person's sexuality doesn't disappear because he or she has epilepsy. However, some people with epilepsy have a low sex drive, while others have difficulty with sexual response, i.e., impotence and painful intercourse. Some of the sexual dysfunction reported by people with epilepsy is psychosocial in nature, for example, low self esteem or the fear of having a seizure during relations. Physical reasons cannot be discounted, however. It's possible that the abnormal discharge of electrical activity within the brain affects desire and arousal. Significantly, AEDs affect the same areas of the brain responsible for sexuality, as well as cause changes in hormone metabolism.
While patients often hesitate to discuss sexual difficulties with a physician, the encouraging news is that these problems can sometimes be alleviated. For example, the cause of painful intercourse may be vaginal dryness, for which lubricating creams or gels can be recommended. Medication can be prescribed to help men overcome impotence. A doctor might prescribe a different AED to help alleviate sexual difficulties, as a person may encounter sexual problems while using one drug but not another.
Birth control is an important issue for couples who want to avoid an unintended pregnancy. A gynecologist can discuss the pros and cons of the various methods of birth control, but women with epilepsy should know that some antiepileptic drugs can reduce the effectiveness of hormonally based contraceptives (such as the Pill, implanted protection, and hormone injections). It is often recommended that a second form of birth control ("barrier" protection such as a diaphragm or condom) be used along with hormonal contraception.
While the pregnancies of women with epilepsy are high risk, the vast majority - more than 90 percent - result in the birth of a healthy baby. It's important that the pregnancy be planned so that prenatal care can begin as early as possible-even before conception.
Prenatal vitamins, a significant part of any pregnancy, are especially critical for women with epilepsy. Two antiepileptic drugs (AEDs) in particular - sodium valporate and Tegretol - are associated with an increased rate of spina bifida, a neural tube defect, and a woman may be taking one of these medications before she knows she is pregnant. Folic acid, which is found in most prenatal vitamins, reduces the risk of neural tube defects.
Another important factor for a healthy pregnancy is the level of antiepileptic drugs the mother-to-be takes. Ideally, she should be taking the lowest dosage of AED possible that will completely control her seizures. Taking multiple AEDs during pregnancy has been associated with a greater incidence of birth defects. But no woman with epilepsy should discontinue her medications without the consent of her doctor.
About one-third of women with epilepsy experience an increase in seizure activity during pregnancy. This can be due to lack of sleep (also a trigger for seizures in people who are not expecting); changes in how the woman's body metabolizes the AED; failure to take AEDs as directed; or a decline in blood levels.
Once a woman is in the last several weeks of pregnancy, Vitamin K supplements often are recommended to reduce the risk of a blood-clotting disorder in the baby that results from fetal exposure to AEDs.
Because the pregnancy is considered high risk, pregnant women with epilepsy will undergo more tests and screenings than other women. Several ultrasounds of the developing fetus may be ordered during the pregnancy, and possibly an amniocentesis. Even with prenatal care, the potential exists for difficulties with the pregnancy. Some studies indicate that babies born to women with epilepsy have a higher rate of developmental delays; whether this is because of the effects of AEDs, the epilepsy itself, or factors unrelated to epilepsy is not clear. If a seizure causes a woman to fall, there may be injury to the fetus; rarely during convulsions, the fetus can be deprived of oxygen. Even seizures that do not cause convulsions can produce uterine contractions that result in stillbirth, bleeding, or miscarriage. However, it bears repeating that most of the time, a woman with epilepsy will give birth to a healthy child.
During menopause, when menstrual cycles end, levels of both estrogen and progesterone decrease. How lower levels of these hormones affect seizure frequency varies with the individual. Significantly, hormone replacement therapy (HRT)is sometimes recommended for menopausal women to reduce the risk of heart disease and osteoporosis. However, HRT also is associated with an increased occurrence of certain cancers. The risks and benefits of taking supplemental estrogen and progesterone is a matter to discuss with a physician for all menopausal women, but especially for those with epilepsy, since estrogen tends to increase seizure frequency, while progesterone can reduce it.
The Golden Years
At the same time the rate of epilepsy is declining in younger people, it is increasing among those over age 60. Medical conditions that commonly occur in seniors - such as strokes and the hardening and narrowing of blood vessels in the brain - can make a person more susceptible to epilepsy.
Epilepsy can be well controlled in seniors. However, the side effects of antiepileptic drugs (AED) tend to be more severe with people in this age group. Seniors often take medication for other conditions, and there may be an adverse interaction between the AED and the other drugs. It is important that elderly patients tell their doctors about all the medications they take.