Live a Full Life, with Everyone, Like Everyone – in spite of Epilepsy
Epilepsy is a brain disorder characterized by recurrent fits, convulsions or seizures. This is due to abnormal electrical discharges from structurally or functionally disturbed areas of the brain.
Women with epilepsy on reaching menopause may observe a reduction, but rarely an increase in their seizures. They have a two- to sixfold increase in fractures as well.
The critical issue for these women is bone health, which deteriorates due to aging and loss of female hormones, and culminates in the thinning of bones (osteoporosis), long-term consumption of anticonvulsants being the culprit. Usually antiepileptic drugs have to be modified by supplementation with Vitamin D and Calcium; also regular physical exercise is advised to protect bone health.
Dr. Prithika Chary, Chief neurologist at Kauvery hospital has specialized in the care of patients with epilepsy. She has transformed, over the years, anxious lives of hundreds of epileptic women into stress-free study, work, marriage and safe pregnancy. All of them with a sense of joy and fulfilment now “Live a full life, with everyone, like everyone in spite of epilepsy”.
The cause is unknown in most cases of patients. In young children it can be due to birth injuries, reduced blood or oxygen to the brain at birth, changes in chemicals in the blood, congenital malformations, and the consequent brain infections. In adults, especially the elderly, degenerative brain changes and problems of blood supply can lead to epilepsy.
Several daily life style habits can trigger seizures in people with epilepsy. Missing sleep or inadequate sleep is an important factor which often provokes seizures. Missing meals can lead to a drop in the blood sugar and induce seizures. Prolonged television viewing or onscreen work, high ambient temperature, fever, intercurrent infections, excitement, overexertion and emotional disturbances, can all provoke seizures. It is therefore necessary to have at least 6-8 hours of sleep every night, eat regular meals, avoid prolonged exposure to the sun, and get treated for infections and fever promptly in addition to taking the antiepileptic medications regularly.
Women with epilepsy face unique problems related to their hormonal cycles. The life of a woman consists of several challenges – childhood, adolescence and menarche (the first menstrual period), childbearing and contraception, fertility and pregnancy issues, and menopause or cessation of menstrual periods. The two main female hormones oestrogen and progesterone do influence epilepsy. Some women may have more seizures when their hormones undergo changes. This happens in 10-12% of women.
Some girls, on attaining puberty (menarche), may have seizures aggravated during menstruation. Seizures may be worse just before the start of the periods, or at the beginning of the period (when their progesterone levels drop), or during ovulation (when there is a lot of oestrogen in the body). Another type may occur during the last half of the cycle when an egg is not released (an anovulatory cycle). This type of epilepsy is called catamenial epilepsy and though it is uncommon, is a unique problem of the girl child with epilepsy.
During adolescence, boys and girls are acutely conscious of their body image. As mentioned above, the side effects of some of the antiepileptic drugs have to be avoided. The incidence of polycystic ovarian disease is a crucial problem that is more common in girls with epilepsy than in the general population, and particularly in those who are on a specific anticonvulsant called valproate. This can lead to a syndrome of obesity, hirsutism and irregular periods.
Hence, great care has to be taken in choosing the right drug for such patients.
Contraception is another issue in the adolescent girl with epilepsy, which needs to be addressed. Oral contraceptives interfere with and modify the blood levels of several antiepileptic drugs, and hence there can be an increase or decrease in the efficacy of the drug. Also some antiepileptic drugs interfere with the metabolism of the oral contraceptive, and can lead to contraceptive failure.
Pregnancy is a period of joy as well as anxiety for all women. Women with epilepsy, however, are often justifiably fearful of the effects on the foetus of both their epilepsy and the antiepileptic drugs they take. Co-ordinated care of both an obstetrician and a neurologist is needed for such women throughout the period of their pregnancy. Avoiding seizures during pregnancy is critical for the safety of both mother and baby. This is done by ensuring the use of appropriate drugs in appropriate doses with adjustments being made as and when necessary throughout the term. Delivery should be planned at a hospital capable of handling high risk pregnancies with adequate facilities for good neonatal care. A majority of women with epilepsy have uneventful pregnancies with good outcome to mother and foetus. Issues of breast feeding and postpartum adjustment of antiepileptic drugs should be discussed.
Women with epilepsy on reaching menopause may observe a reduction, but rarely an increase in their seizures. They have a two- to sixfold increase in fractures as well. The critical issue for these women is bone health, which deteriorates due to aging and loss of female hormones, and culminates in the thinning of bones (osteoporosis), long-term consumption of anticonvulsants being the culprit. Usually antiepileptic drugs have to be modified by supplementation with Vitamin D and Calcium; also regular physical exercise is advised to protect bone health.
Dr. Prithika Chary, Chief neurologist at Kauvery hospital has specialized in the care of patients with epilepsy. She has transformed, over the years, anxious lives of hundreds of epileptic women into stress-free study, work, marriage and safe pregnancy. All of them with a sense of joy and fulfilment now “Live a full life, with everyone, like everyone in spite of epilepsy”.
Article by Dr. Prithika Chary, Chief Neurologist
