menstruation

Seizures may occur just before or during a period. Medical opinion is divided as to why this is - some think it is due to changes in the levels of the hormones Oestrogen and Progesterone (chemical messengers which determine the bodily changes throughout the menstrual cycle). Others think that it may be due to changes in the level of body fluids.

contraception

Many couples use contraception before starting a family and the timing of conception can now be controlled. Appropriate methods of contraception should be discussed with the doctor as some anti-epileptic medications can interfere with the effectiveness of opal contraception. The doctor may alter the dosage, change the medication, or recommend an alternative method of contraception.

pregnancy

Antenatal Booking

At your first visit to your midwife/GP, make it clear that you have epilepsy. Discuss:

your type of seizures

their nature

their length

their pattern and frequency

any contributing factors that you feel may trigger seizures (e.g. noise)

what medication(s) you are taking

whether your partner has epilepsy

It is always helpful is someone who has witnessed your seizures can go with you to the clinic.

anti-epileptic medication

Many body changes occur during pregnancy and these can affect your medication. It is important that you continue to take your medication and have regular drug level monitoring to minimize the risk of seizures. It is unlikely that the Doctor will withdraw drug treatment complexly as this could result in increased seizures. Any medication absorbed by the fetus will pass out of the baby’s system within a few days after birth.

Taking any medication can be worrying during pregnancy and some anti-epileptic medication slightly increases the risk of neural tube defects (e.g. spina bifida) in the foetus. This risk can be minimized by taking folic acid for 2 months prior to conception and continued for the first 3 months of pregnancy.

the effects of seizures

While it is natural to worry about the effects of seizures on an unborn child, most women with epilepsy have a trouble-free pregnancy and produce normal healthy children. While it is unlikely that the foetus will be injured during a seizure you should inform your Doctor and have an examination.

seizure pattern

Pregnancy may affect your seizure pattern. Seizures may become more or less frequent or stop altogether. Rest is important, as fatigue will lower your seizure threshold.

vitamin deficiency

Some anti-epileptic medication reduces the level of Vitamin K in the bloodstream which can affect the bloods clotting mechanism. The Doctor may recommend that Vitamin K is taken by a mother for 4 weeks before the baby is due and by the baby for a short while after birth.

screening tests

Most women will be offered a test to screen for abnormalities in the foetus. This usually involves a blood test at 16-20 weeks to check the level of alpha feto-protein(AFP). An ultrasound scan may also be done at your initial hospital visit, and possibly again if your doctor suspects a problem. However, it is important to maintain a sense of perspective, and to remember that these tests are not infallible.

before labour

You will be able to discuss a care plan for the actual labour with your midwife. Topics covered will include the most comfortable positions, pain relief, possible seizure triggers (e.g. noise) and whom you would like to have with you during the delivery.

during labour

You will generally be advised to have a hospital delivery to ensure a safe delivery. A midwife will be present during and after the birth. Remind the midwife and staff that you have epilepsy and try to get as much rest as possible. Ask someone to ensure that you take your medication during labour.

after the birth

Breast Feeding - The effect of medication on breast milk will depend on the medication being taken and advice should be sought from your Doctor. Usually very little, in any, is passed on to the baby and it will quickly pass out of the baby’s system.

At Home - Seizures may become more frequent or slightly different in character following birth. If this happens, continue taking medication as usual, but seek medical advice. Accept any offers of assistance with the baby as sleep deprivation can lower your seizure threshold. Follow basic safety procedures.

Any parent with epilepsy will have anxieties but the pleasure you get from a new born baby shouldn’t be affected by the fact that you have epilepsy.

the menopause and hormone replacement (HRT)

This is a time of hormonal upheaval and physical change. Some women develop epilepsy at this time while others find their seizures cease. HRT may help with short term symptoms (e.g. flushes/sweats), protect against heart disease and brittle bone disease, osteoporosis. (This is particularly relevant as some anti-epileptic drugs affect the body’s calcium balance and so the risk of osteoporosis is increased). However, HRT is not suitable for everyone and can adversely affect epilepsy.

further reading

‘Women and Epilepsy’. ed. Mr Trimble (Wiley, Chichester, 1991)

‘Living with epilepsy’. D Chadwick and S Usiskin {Macdonald Optima, London 2nd edition 1991}

‘Epilepsy in Women’. D Schmitt, extract: Textbook of Epilepsy, ed, J Laidlaw, A Richens and D Chadwick (Churchill Livingstone, Edinburgh, 4th edition, 1993).

‘Guidelines for Mothers with Epilepsy’ Royal College of Midwives 1991