SYMPOSIUM ON EPILEPSY .7. EPILEPSY IN WOMEN

Physicians should be aware of certain gender-related issues in the tre atment of women with epilepsy, Although in the past reproduction was d iscouraged in women with epilepsy, more than 90% of the pregnancies in such patients currently have an uneventful outcome with appropriate m anagement, Oral contraceptive agents are not contraindicated in women with epilepsy; however, the contraceptive failure rate increases fourf old if patients are being treated concurrently with enzyme-inducing an tiepileptic drugs, In pregnant patients, free drug levels of carbamaze pine, phenobarbital, phenytoin, and valproate may change because of al terations in protein binding, clearance, and possible absorption, The dosage should be adjusted if the patient's seizures are increasing, Wo men with epilepsy may have disease-related or treatment-related menstr ual dysfunction, complications of pregnancy (slightly increased risk o f toxemia and fetal loss), endocrine dysfunction, appearance changes ( a general coarsening of facial features with long-term administration of antiepileptic agents), and psychosocial maladjustment, Some effects are drug specific, Although control of seizures remains the primary g oal of treating women with epilepsy, the widening choice of antiepilep tic drugs may facilitate optimal management of secondary and gender-sp ecific complications.