BrainWaves #26 Considerations in the management of women with epilepsy

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.

Originally released: July 18, 2017

There's more to epilepsy than AED titration. (Shocking, I know.) Especially in women, management is undeniably complex. For example, the same enzymatic machinery used to metabolize AEDs is also used to break down estrogen-containing oral contraceptives--an interaction that could literally open a Pandora's box of complications. These and other issues affecting the management of women with epilepsy are addressed by Dr. Danielle Becker in this week's BrainWaves podcast. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. This episode was vetted and approved by Danielle Becker.

REFERENCES

Crawford P. Best practice guidelines for the management of women with epilepsy. Epilepsia 2005;46 Suppl 9:117-24. PMID 16302885

Harden CL, Hopp J, Ting TY, et al. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 2009;73(2):126-32. PMID 19398682

Herzog AG, Fowler KM, Smithson SD, et al. Progesterone vs placebo therapy for women with epilepsy: a randomized clinical trial. Neurology 2012;78(24):1959-66. PMID 22649214

Meador K, Reynolds MW, Crean S, Fahrbach K, Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res 2008;81(1):1-13. PMID 18565732

Meador KJ, Baker GA, Browning N, et al. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr 2014;168(8):729-36. PMID 24934501

Reiter SF, Bjørk MH, Daltveit AK, et al. Life satisfaction in women with epilepsy during and after pregnancy. Epilepsy Behav 2016;62:251-7. PMID 27513352

Taubøll E, Sveberg L, Svalheim S. Interactions between hormones and epilepsy. Seizure 2015;28:3-11. PMID 25765693

Velíšková J, Desantis KA. Sex and hormonal influences on seizures and epilepsy. Horm Behav 2013;63(2):267-77. PMID 22504305

We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.