Special considerations for women with epilepsy

Women with epilepsy present health care providers with unique problems and opportunities for advancement of care. The fundamentals of epileptic pathop hysiology are similar in both sexes. There are, however, some significant d ifferences. Cosmetic effects of antiepileptic drugs (AEDs) may have differe nt implications for women. Women who have seizures associated with their me nstrual cycle may need special attention regarding their cyclic hormonal ch anges and AED selection. Antiepileptic drugs may reduce the effectiveness o f hormonal contraception. Women with epilepsy have higher rates of infertil ity and an increased prevalence of reproductive and endocrine disorders. Th e majority of women with epilepsy have normal, healthy children, but their pregnancies are considered high risk due to an increase in seizure frequenc y, metabolic alterations of AEDs (which complicate management), and an incr eased risk of adverse pregnancy outcomes. These issues and an approach to o ptimize the management of women with epilepsy are discussed.