Reproductive Concerns in Women with Epilepsy

October 10th, 2009

This is a research paper I wrote in my Spring ’05 English class at Humboldt State. It doesn’t contain any groundbreaking research, but I thought I’d put it out there in hopes that it would help or interest somebody.

Reproductive Concerns in Women with Epilepsy

The Epilepsy Foundation, among other groups, reports that women with epilepsy have lower fertility rates tan non-epileptic women. What is the reason behind this? Is the reason connected to the seizures, or the medication or could it be partly social? Beyond simply asserting that people with epilepsy do in fact suffer from fertility issues, this paper will go on to assert that many common treatments for epilepsy can compound the problem.

Before discussing these terms, a brief introduction to epilepsy is in order. Epilepsy is an umbrella term referring to many types of seizure disorders. Although there are some seizure disorders not categorized as epilepsy, epileptic seizures are the result of a scar on the brain that can cause irregular electrical activity. “Healthy” brain activity involves special cells, called neurons, exchanging electrical impulses. Sometimes, in the scarred tissue, these neurons misfire, resulting in a seizure.

Seizures can be localized to one area of the brain as with partial or complex-partial seizures, or they can be generalized, as with tonic-clonic. Tonic-clonic seizures, sometimes called grand mal seizures, are best know ad most frequently depicted involving convulsions and loss of consciousness. Partial and complex-partial seizures are more subtle and can go unnoticed. The area in the brain where the seizure occurs dictates how that seizure will manifest, but may involve staring off into space, violent outbursts, visual and/or auditory hallucinations, or temporal disorientation. A person suffering from epilepsy can have one or both of these types of seizures. In come cases a seizure will start out as a (complex-)partial episode and generalize to the whole brain.

Difficulty controlling generalized and otherwise difficult to conceal seizures can isolate a person who suffers from epilepsy. For the parent of a child with uncontrolled epilepsy, they may be afraid to let the child out of their sight, fearing that the child may have a seizure. This keeps the child from developing the social skills necessary to develop and maintain relationships throughout life. Adults who develop epilepsy may be afraid to leave their homes for the same reason, possibly perceiving a stigma associated with the disorder. This isolation keeps them from maintaining current relationships as well as from forming new ones. Epilepsy Action, a British non-profit group, postulated that these reasons may partially account for the low birth-rate among epileptic women (Epilepsy). In these cases, conventional fertility issues fall by the wayside, since a prerequisite to conception is a willing partner.

Many epileptics develop and function normally, but still have difficulty conceiving. In her 1993 book Seized, Eve LaPlante explains how seizures can interfere with fertility, “Normal fluctuations of hormones in th body are known to influence seizure frequency, and seizures in turn affect the levels of hormones. According to doctors, 50 percent of women with [temporal lobe epilepsy] have irregular or no menstrual periods, hamper[ing] fertility.” (LaPlante 175) When seizures are localized to one area of the brain, as in temporal lobe epilepsy, they can interfere with the functions of that area of the brain. The temporal lobe is responsible for, among other things, regulating hormones. Fertility, in the case of women with epilepsy, does not simply refer to the introduction of sperm to egg. Women with epilepsy also have more trouble carrying a baby to term due to an increased risk of miscarriage[citation needed].

The idea that epilepsy can interfere with a pregnancy is not a universally accepted fact. In Current Obstetric & Gynecologic Diagnosis & Treatment, written by a team of mostly MDs and PhDs, edited by Ralph C. Benson, Professor Of Obstetrics & Gynecology at Oregon Health Sciences University, states, “Epilepsy has no demonstrable effect on the clinical course of pregnancy” (Benson 885). There is a possibility that, in 1984, when this manual was published, there had simply not been enough research to show a risk. However, even if updated editions do acknowledge the connection between epilepsy and fertility, many healthcare providers don’t. A 2000 study of “3535 healthcare professionals across a wide range of specialties” published in Journal of Women’s Health & Gender-Based Medicine found, “Most respondents did not know the specific effects of estrogen and progesterone on the seizure threshold, were not aware of menstrual-associated seizure patterns, and could not identify which anti-epileptic drugs interfere with oral contraceptives. The majority of respondents did not know that women with epilepsy have higher rates of infertility, reproductive endocrine disorders, and sexual dysfunction” (Morrell, Sarto and Shafer et al.) Women who do not wish to become pregnant will continue relying on faulty methods of birth control, unintentionally running the risk of an unplanned pregnancy. Women who do wish to become pregnant will be unaware of why they’re experiencing difficulty. If a woman knew this from the outset, she could consult a fertility specialist as soon as they made the decision to become pregnant. For a woman whose biological clock is ticking, this preemptive measure could make all the difference.

Whatever the relationship to or knowledge about seizures and fertility, very few dispute the potentially disastrous effects of anti-epileptic drugs. Individuals associated with Departments of Neurology, Tampa General Hospital, University of South Florida, Thomas Jefferson University, and Johns Hopkins University performed a study entitled “Updates on the Treatment of Epilepsy in Women”. The abstract states, “the interaction of anti-epileptic drugs and endocrine function that can affect ovarian function, induce polycystic ovary (PCO)-like syndrome, and threaten fertility.” (Tatum and Liporace et al 9) Polycystic ovary syndrome is a condition characterized by menstrual irregularities, excess testosterone and, as the name suggests, ovarian cysts. Anti-epileptic drugs may add further difficulties to an already difficult task.

Removing the drugs may do more harm than good. In a book by University of Minnesota Clinical Professor of Neurology and Pharmacy Ilo E. Leppik, the author asserts that, “reducing medication may lead to a greater risk of seizures, which can also harm the fetus. Abrupt discontinuation may precipitate seizures or status epilipticus” (Leppik 138). While seizing, the brain doesn’t receive sufficient oxygen it needs, potentially leading to brain damage in an adult, and any number of damages or birth defects for a developing fetus. During status epilepticus, a patient has uncontrollable seizures immediately following one another. If nothing can be done to stop status epilepticus, it can result in brain death, followed by bodily death.

For women who do manage to conceive, the road is filled with danger. Bud Hruby is a PA who works at Humboldt Neurological Medical Group. He cited Dilantin as causing symptoms similar to those found in Fetal Alcohol Syndrome. (Hruby) Fetal Alcohol Syndrome typically manifests as stunted growth, facial malformations as well as neurological, the central nervous problems and learning disabilities.

While he recommended Tergretol as the drug of choice, it is not the only drug available to pregnant women (Hruby). Today, many new drugs on the market are Category C for pregnancy ā€“ meaning they haven’t been shown to have any deleterious effects on the fetus. However, because Tegretol has been around the longest, it is the most thoroughly tested. It is also available in generic form, a godsend to people who are notoriously uninsurable.

Even under the best of care, not everything is guaranteed to go as planned. The Epilepsy Foundation of America provides information directed towards women as well as their health care providers. According to their statistics, women with epilepsy have a 90% chance of having a healthy baby. The unlucky 10% of mothers may have a baby with a cleft palate, heart abnormalities, spina bifita, cosmetic abnormalities such as wide-set eyes or short upper lip, differently shaped nails, smaller head size, or, according to some researchers, developmental delays or mental retardation. Many of these congenital malformations can be prevented by taking Folic Acid supplements at the beginning of gestation and Vitamin K supplements at the end. At this time, there is no way for a mother-to-be to prevent her offspring from developing a seizure disorder, the likelihood of which is 4 times higher than in families without epilepsy. (Women) This means that for a woman with epilepsy, there are many additional sources of stress. This stress, in addition to the stress of a pregnancy, can cause more seizures, which can require further medication, yet another source of stress.

While medicine still does not have hormones and fertility down to an exact science, when complicated by issues like epilepsy and anti-epileptic drugs, it can be next to impossible to tell what is causing what. Although conflicting data exists, it’s entirely likely that each factor is just that ā€“ a factor. The degree to which any given factor affects a person will probably vary from person to person. However, despite conflicting data, we can be sure that each will exert some influence. The key is not so much to know what’s responsible for what else, although that’s certainly gratifying, as it is to know how to balance the risks of birth defects resulting from seizures and the risks of anti-epileptic drugs and the risks associated with no anti-epileptic drugs.

Works Cited

Benson MD, Ralph C. Ed. Current Obstetric & Gynecologic Diagnosis & Treatment. 5th ed. Los Altos: Lange Medical Publications, 1984.

Epilepsy Action: Epilepsy and Relationships. Epilepsy Action. 14 April 2004.

Hruby, Bud, P.A. Personal Interview. 30 March 2004.

LaPlante, Eve. Seized. New York: HarperCollins, 1993.

Leppik MD, Ilo E. Contemporary Diagnosis and Management of the Patient With Epilepsy. Newtown: Handbooks in Health Care, 2001.

Morrell, Martha J. Gloria E. Sarto, Patricia Osborne Shafer et al. “Health Issues for Women with Epilpsy: A Descriptive Survey to Access Knowledge and Awareness among Healthcare Providers.” Journal of Women’s Health & Gender-Based Medicine 9.9 (2000): EBSCOhost. Humboldt State U, Lib 14 April 2004. <http://search.epnet.com/ezpoxy.humboldt.edu/direct.asp?an=5323894&db=afh>

Tatum, William O. IV, Joyce Liporace, Selim R. Benbadis et al. “Updates on the Treatment of Epilepsy in Women”. Archives Of Internal Medicine 164.2 (2004): 9. Abstract. <http://search.epnet.com/direct.asp?an=12019866&db=afh>

Women and Epilepsy. The Epilepsy Foundation. 6 April 2004. <http://www.epilepsyfoundation.org/answerplace/Life/adults/women/weipregnancy.cfm>

Works Consulted

Baker, Sing M.A. Personal interview. 17 March 2004.

Benson MD, Ralph C. Ed. Current Obstetric & Gynecologic Diagnosis & Treatment. 5th ed. Los Altos: Lange Medical Publications, 1984.

Epilepsy Action: Epilepsy and Relationships. Epilepsy Action. 14 April 2004.

Fadiman, Annie. The Spirit Catches You and You Fall Down. New York: Farrar, Straus and Giroux, 1997.

Henderson, C.W. “Affected Women Poorly Managed During Pregnancy.” Women’s Health Weekly (2000): 7. EBSCOhost. Humboldt State U, Lib. 8 April 2004.

Holmes, Lewis B., Elizabeth A, Harvey, Brent A. Coull et al. “The Teratogenicity Of Anticonvulsant Drugs”. New England Journal of Medicine 344.15 (2001): 1132: EBSCOhost. Humboldt State U, Lib. 8 April 2004.

Hruby, Bud, P.A. Personal Interview. 30 March 2004.

LaPlante, Eve. Seized. New York: HarperCollins, 1993.

Leppik MD, Ilo E. Contemporary Diagnosis and Management of the Patient With Epilepsy. Newtown: Handbooks in Health Care, 2001.

“Mission Statement”. The Epilepsy Foundation. 6 April 2004.

Morrell, Martha J. Gloria E. Sarto, Patricia Osborne Shafer et al. “Health Issues for Women with Epilpsy: A Descriptive Survey to Access Knowledge and Awareness among Healthcare Providers.” Journal of Women’s Health & Gender-Based Medicine 9.9 (2000): EBSCOhost. Humboldt State U, Lib 14 April 2004.

Ramachandran M.D.. Ph.D., V.S. And Sandra Blackslee. Phantoms In The Brain. New York: HarperCollins, 1998.

Sacks, Oliver. An Anthropologist On Mars. New York: Knopf, 1995.

“Study finds epileptic women have lower fertility rates.” Women’s Health Weekly. (1999): 9. EBSCOhost. Humboldt State U, Lib. 7 April 2004.

Tatum, William O. IV, Joyce Liporace, Selim R. Benbadis et al. “Updates on the Treatment of Epilepsy in Women”. Archives Of Internal Medicine 164.2 (2004): 9. Abstract.

Trimble, Michael R. The Psychopharmacology Of Epilepsy. Chichestet: John Wiley & Sons, 1985

Tucker MRCOG, D.E. “Polycystic ovary syndrome”.

What Is Fecal Alcohol Syndrome? National Organization on Fetal Alcohol Syndrome. 14 April 2004.

Women and Epilepsy. The Epilepsy Foundation. 6 April 2004.

[citation needed] In subsequent research on the topic, I’m unable verify the alleged correlation between epilepsy and miscarriages. I found lots of sources to confirm that maternal seizures increase the risk of miscarriage, but nothing indicating that the presence of epilepsy alone makes one more prone to miscarriage. I suspect, when initially writing this paper, I failed to realize there was such a distinction.

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