Current issues on epileptic women

Issues linked to epileptic women are being reviewed. Ovarian steroid hormon es have a number of effects on the brain that predispose to epileptic activ ity. In particular, estradiol produces changes in the hippocampus synapses predisposing hyperexcitability associated with seizures. Also, menses and m enopause periods, in which there are changing levels of steroid ovarian hor mones, are associated with a particular appearing of seizures (catamenial e pilepsy) and with phenoptypic changes of previous ones. Epilepsy can affect the reproductive system, inducing endocrinal abnormalities (through disrup tion of cortical regulation of hypothalamus hormone release, and changes in the central nervous system concentration of steroid hormones induced by an tiepileptics), infertility (linked to abnormalities in menstrual cycle or t o the occurrence of polycytic ovaries, particularly in association with val proate treatment), and sexual disfunction (namely related to physiologic de fects). Oral hormonal contraceptives should be performed using a pill with greater than or equal to 50 mu g of estrogen in order to prevent its potent ial loss of efficacy induced by enzyme-inducing antiepileptics. Concerning pregnancy, some topics should be discussed with, and advised to epileptic w omen, including: the possibility of withdrawal antiepileptics and the need of folic acid supplementation when planning a pregnancy; the risk of increa sed seizure frequency during pregnancy, and of the occurrence of obstetric complications; the increased risk of teratogenesis associated with antiepil eptic therapy (mainly if in polytheraphy); the need of vitamin K supplement ation during the last month of pregnancy in order to avoid newborn haemorrh ages; and the general absence of risk of breastfeeding even under sustained antiepileptic therapy.