PHARMACOTHERAPEUTIC ISSUES FOR WOMEN OF CHILDBEARING AGE WITH EPILEPSY

OBJECTIVE: To provide an overview of key pharmacotherapeutic issues in epilepsy for the woman of childbearing potential. DATA SOURCES: A MED LINE search (1966-1997) was done to identify pertinent literature. Cha pters in epilepsy textbooks, pregnancy registries, and their respectiv e bibliographies were also evaluated. STUDY SELECTION AND DATA EXTRACT ION: AU identifiable sources written in English were evaluated. DATA S YNTHESIS: Epilepsy is a common neurologic disorder. It is estimated th at nearly 1 million American women of childbearing age have epilepsy. There are many women's health issues in epilepsy. These include menstr ual cycle influences on seizure activity, contraceptive-antiepileptic drug interactions, pharmacokinetic changes during pregnancy, teratogen icity of antiepileptic drugs, breast-feeding, and quality of life. The se issues challenge both the woman with epilepsy and the many healthca re providers involved in her care. This article reviews these issues a nd makes recommendations. It addresses both the first-generation antie pileptic drugs (phenobarbital, phenytoin, carbamazepine, valproic acid ) and the newer or second-generation agents (felbamate, gabapentin, la motrigine, topiramate, tiagabine). CONCLUSION/RECOMMENDATIONS : Drug i nteractions between enzyme-inducing antiepileptic drugs and contracept ives are well documented. Higher doses of oral contraceptives or a sec ond contraceptive method are suggested if epileptic women use an enzym e-inducing antiepileptic drug. Planned pregnancy is highly recommended and counseling before conception is crucial. Prepregnancy counseling should include, but is not limited to, folic acid supplementation, opt imal control of seizure activity, monotherapy with the lowest effectiv e antiepileptic drug dose, and medication adherence. Patient informati on should be provided about the risk of teratogenicity and the importa nce of prenatal care. Antiepileptic drug dosage adjustments may be nec essary and should be based on clinical symptoms, not solely on serum d rug concentrations. While the future holds promise for many aforementi oned women's issues in epilepsy, many questions remain to be answered.