Due to the special physiological characteristics of women with epilepsy, treatment measures should take full account of reproduction, pregnancy, childbirth, and other aspects of the condition.
I. Puberty and epilepsy
1. adolescence is one of the most frequent periods of epilepsy in females
2. it is necessary to re-evaluate the diagnosis and seizure type in diagnosed patients entering adolescence to ensure the most effective treatment plan
3. treatment regimens should take full account of patient compliance, sensitivity to adverse effects of certain antiepileptic drugs, and the impact on fertility.
II. Fertility
Emphasis on the reproductive function of women with epilepsy is one of the most important aspects of improving the quality of life of patients.
1. seizure control.
2. Patients who have not yet had children should try to avoid drugs that may affect reproductive function, such as valproic acid drugs.
3. Patients who are planning to have children are advised to plan their pregnancies under the guidance of their doctors.
Contraception
Contraception is a common problem for women with epilepsy during their childbearing years, and it is necessary to give advice to patients about contraception. Women with epilepsy taking enzyme-inducing antiepileptic drugs have a significantly higher chance of failing to take oral contraceptives. Non-enzyme-inducing antiepileptic drugs have no effect on oral contraceptives. Enzyme-inducing antiepileptic drugs include: carbamazepine, oxcarbazepine, phenobarbital, paroxetine, topiramate; non-enzyme-inducing AEDs include: benzodiazepines, acetazolamide, ethosuximide, gabapentin, lamotrigine, levetiracetam, tiagabine, sodium valproate, and aminoglutethimide.
(i) Compounded oral contraceptives
When patients take oral contraceptives, it is more appropriate to apply non-enzyme-inducing antiepileptic drugs;
Patients taking enzyme-inducing antiepileptic drugs are advised to use condoms and other contraceptive methods to achieve optimal contraception;
If compounded oral contraceptives are used in conjunction with enzyme-inducing antiepileptic drugs, the minimum dose of estradiol should be 50 micrograms per day; if breakthrough bleeding occurs, the dose of estradiol should be increased to 75 to 100 micrograms per day.
(ii) Progesterone single contraceptive pill
1. Oral progesterone single contraceptive is not recommended for patients taking enzyme-inducing antiepileptic drugs.
2. Patients taking enzyme-inducing antiepileptic drugs can apply injectable long-acting progesterone, but it must be injected every 10 weeks.
3, Patients taking enzyme-inducing antiepileptic drugs should not apply progesterone implant tablets.
(3) Emergency contraception: Patients taking enzyme-inducing antiepileptic drugs should take 1.5 mg first and then 750 mcg 12 hours later when taking levoprogesterone for emergency contraception.
IV. Pre-conception counseling
Epilepsy is a common disorder in women of childbearing age. Pregnancy in women with epilepsy may increase the risk of seizures, various complications and malformations in the offspring, and preconception counseling is necessary for women with epilepsy.
The majority of women with epilepsy can have normal pregnancies and deliveries with the guidance of their physicians;
2. Inform the patient of the risks of epilepsy and antiepileptic drugs for pregnancy and fetus;
3. Inform the patient of the need for folic acid and vitamin K supplementation.
Effects of seizures on the pregnant woman and her fetus
1. 15%-30% of women with epilepsy have an increase in seizures during pregnancy;
2. Effects of seizures on pregnant women: mainly increased pregnancy complications, such as vaginal bleeding, miscarriage, preterm delivery, obstructed labor and gestational hypertension syndrome;
3. The effect of seizures on the fetus: mainly perinatal fetal complications and neonatal malformations increase;
4. Inform the patient of the risks of poor seizure control to the fetus and themselves.