Sep 22, 2016
There's more to epilepsy than AED titration. (Shocking, I know.) Especially in women, management is undeniably complex. For example, the same enzymatic machinery used to metabolize AEDs is also used to break down estrogen-containing oral contraceptives--an interaction that could literally open a Pandora's box of complications. These and other issues affecting the management of women with epilepsy are addressed by Dr. Danielle Becker in this week's BrainWaves podcast. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. This episode was vetted and approved by Danielle Becker. REFERENCES 1. Meador K, Reynolds MW, Crean S, Fahrbach K and Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008;81:1-13. 2. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW and Neurodevelopmental Effects of Antiepileptic Drugs Study G. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168:729-36. 3. Veliskova J and Desantis KA. Sex and hormonal influences on seizures and epilepsy. Horm Behav. 2013;63:267-77. 4. Herzog AG, Fowler KM, Smithson SD, Kalayjian LA, Heck CN, Sperling MR, Liporace JD, Harden CL, Dworetzky BA, Pennell PB, Massaro JM and Progesterone Trial Study G. Progesterone vs placebo therapy for women with epilepsy: A randomized clinical trial. Neurology. 2012;78:1959-66. 5. Tauboll E, Sveberg L and Svalheim S. Interactions between hormones and epilepsy. Seizure. 2015;28:3-11. 6. Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia. 2005;46 Suppl 9:117-24. 7. Reiter SF, Bjork MH, Daltveit AK, Veiby G, Kolstad E, Engelsen BA and Gilhus NE. Life satisfaction in women with epilepsy during and after pregnancy. Epilepsy Behav. 2016;62:251-257. 8. Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, Wiebe S, Gronseth GS, Thurman D, Meador KJ, Koppel BS, Kaplan PW, Robinson JN, Gidal B, Hovinga CA, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Le Guen C, American Academy of N and American Epilepsy S. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:126-32.