Open Access
CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2016; 52(04): 202-210
DOI: 10.1055/s-0040-1712736
Original Article

Reproductive Issues of Women with Epilepsy

Sanjeev V. Thomas
1   Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, India.
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ABSTRACT

There are about 10 million people with epilepsy in India and a quarter of them are women in reproductive age group. The social stigma of epilepsy has pervasive impact on the life of people with epilepsy particularly women. The cyclical hormonal changes during menstrual cycle and during pregnancy can influence the seizure pattern in women with epilepsy. Exposure to antiepileptic drugs (AEDs) can increase the risk of fetal malformations in the infants. This risk is higher with polytherapy and valproate in higher doses. A small proportion of children with antenatal AED exposure can have problems with cognitive development. All women with epilepsy need to have preconception evaluation to simplify the treatment of epilepsy. It is preferable to avoid valproate as an AED antiepileptic drug in women who are planning pregnancy.

BALDEV SINGH ORATION delivered during NAMSCON 2016 at the All India Institute of Medical Sciences, Raipur.




Publication History

Article published online:
07 May 2020

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  • REFERENCES

  • 1 Reynolds EH (2005). Milestones in the history of epilepsy in Atlas: Epilepsy care in the world WHO, Geneva.
  • 2 Hippocrates. The sacred disease. In: The genuine works of Hippocrates. Birmingham AL. The classics of Medicine Library, Gryphon Editions, 1985.
  • 3 Burneo JG (2003). Sonko-Nanay and epilepsy among the Incas. Epilepsy Behav 4(2):181-184.
  • 4 Jilek-Aall L (1999). Morbus sacer in Africa: some religious aspects of epilepsy in traditional cultures. Epilepsia 40(3):382-386.
  • 5 Sridharan R, Murthy BN (1999). Prevalence and Pattern of epilepsy in India. Epilepsia 40:631-636.
  • 6 Mani KS, Rangan G, Srinivas HV, Kalyanasundaram S, Narendran S, Reddy AK (1998). The Yelandur study: a community-based approach to epilepsy in rural South India--epidemiological aspects. Seizure 7(4):281-288.
  • 7 Thomas SV, Sarma PS, Alexander M, et al. (2001). Economic burden of epilepsy in India. Epilepsia 42(8):1052-1060.
  • 8 Thomas SV, Nair A (2011). Confronting stigma of epilepsy. Ann Indian Acad Neurol 14:158-163.
  • 9 Radhakrishnan K, Pandian JD, Santhoshkumar T, et al. (2000). Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India. Epilepsia 41(8):1027-1035.
  • 10 Gopinath M, Sarma PS, Thomas SV (2011). Gender-specific psychosocial outcome for women with epilepsy. Epilepsy Behav 20:44-47.
  • 11 Thomas SV, Deetha TD, Prabhachandran Nair, Sarma PS (2006). Fewer women receive tertiary care for epilepsy in Kerala State, India. Epileptic Disorders 8:184-189.
  • 12 Thomas SV, Deetha TD, Kurup JR, Reghunath B, Radhakrishnan K, Sarma PS (1999). Pregnancy among women with epilepsy. Ann Indian Acad Neurol 2:123-128.
  • 13 Sukumaran SC, Sarma PS, Thomas SV (2010). Polytherapy increases risk of infertility in women with epilepsy. Neurology 75:1351-1355.
  • 14 Thomas SV, Sarma PS, Nirmala C, Mathai A, Thomas SE, Thomas AC (2013). Women with epilepsy and in fertility have different reproductive hormone profile than others. Ann Indian Acad Neurol 16:544-548.
  • 15 Nair SS, Harikrishnan S, Sarma PS, Thomas SV (2016). Metabolic syndrome in young adults with epilepsy. Seizure 37:61-64.
  • 16 Thomas SV, Syam U, Devi JS (2012). Predictors of seizures during pregnancy in women with epilepsy. Epilepsia 53(5):e85-e88.
  • 17 Viale L, Allotey J, Cheong-See F, et al.; for EBM CONNECT Collaboration (2015). Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet 386:1845-1852.
  • 18 Thomas SV, Sindhu K, Ajaykumar B, Devi PB, Sujamol J (2009). Maternal and obstetric outcome of women with epilepsy. Seizure 18:163-166.
  • 19 Tomson T, Battino D, Bonizzoni E, et al.; EURAP study group (2011). Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lanet Neurol 10(7):609-617.
  • 20 Thomas SV, Ajaykumar B, Sindhu K, Nair MK, George B, Sarma PS (2008). Motor and mental development of infants exposed to antiepileptic drugs in utero. Epilepsy Behav 13(1):229-236.
  • 21 Thomas SV, Sukumaran S, Lukose N, George A, Sarma PS (2007). Intellectual and language functions in children of mothers with epilepsy. Epilepsia 48:2234-2240.
  • 22 Gopinath N, Muneer AK, Unnikrishnan S, Varma RP, Thomas SV (2015). Children (10-12 years age) of women with epilepsy have lower intelligence, attention and memory: Observations from a prospective cohort case control study. Epilepsy Res 117:58-62.
  • 23 Bromley RL, Calderbank R, Cheyne CP, Rooney C, Trayner P, Clayton-Smith J, García-Fiñana M, Irwin B, Morrow JI, Shallcross R, Baker GA; UK Epilepsy and Pregnancy Register (2016). Cognition in school-age children exposed to levetiracetam, topiramate, or sodium valproate. Neurology Aug 31. pii: 10.1212/WNL.0000000000003157. PubMed PMID: 27581218.
  • 24 Meador KJ, Baker GA, Browning N, et al.; NEAD Study Group (2009). Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs. NEJM 360(16):1597-1605.
  • 25 Meador KJ, Baker GA, Browning N, et al.; NEAD Study Group (2011). Foetal antiepileptic drug exposure and verbal versus nonverbal abilities at three years of age. Brain 134(Pt 2):396-404.
  • 26 Meador KJ, Baker GA, Browning N, et al.; NEAD Study Group (2013). Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol 12(3):244-252.
  • 27 Adab N, Jacoby A, Smith D, Chadwick D (2001). Additional educational needs in children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 70(1):15-21.