Reproductive Issues In Women With Epilepsy

Hormones affect seizures, and seizures affect hormonal regulation and secretion. Subtle manifestations of hormonal influences on seizures and vice versa may easily be overlooked because they are not usually emphasized In the training of neurologists. Awareness of how different hormones relieve or exacerbate seizures may lead to improvement in the treatment of seizures with the use of adjunctive hormonal therapy. Gender-based differences in AED pharmacokinetics,sex steroid hormones, and reproductive life events raise special issues for women with epilepsy. A prominent precipitation of seizures in association with the menstrual cycle has been termed catamenial epilepsy. This is reported in approximately 55% of women with epilepsy. The most common pattern of clustering of seizures is perimenstrual, typically in the 3 days before and 3 days after onset of the period. Less common patterns are periovulatory ) occurring around ovulation) and luteal, in association with inadequate luteal phase cycles. The mechanism of catamenial epilepsy is thought to be related to the opposite effects of estradiol and progesterone on seizure threshold. Estradiol is a proconvulsant, whereas progesterone has an anticonvulsant effect. Progesterone therapy has been suggested as a treatment when catamenial epilepsy is not responsive to standard AEDs. Reproductive issues are also an important concern of epileptic patients and their families. Both men and women with epilepsy have lower birth rates than the general population and adults with active epilepsy have lower birth rates in comparison to those who no longer have seizures after childhood . Infertility is the failure to conceive after regular intercourse in women who are not using contraception for a duration of 1 year for women <35 years and 6 months for those > 35 years . Signs of infertility may include menstrual irregularity, obesity, hirsutism, an Galactorrhea.Infertility in Women With Epilepsy is likely multifactorial attributed to psychosocial factors, decreased libido, and neuroendocrine alterations secondary to seizures and antiepileptic drugs (AEDs).The hypothalamic-pituitary-gonadal axis (HPG-axis) and feedback inhibitory mechanisms play a key part in infertility among Women With Epilepsy. Reversible/treatable causes of infertility should be identified and addressed if Women With Epilepsy wish to conceive . Understanding the implications of epilepsy and the primary treatment, antiepileptic drugs (AEDs), on reproductive health is necessary and integral in particular to the care of women with epilepsy.

کلیدواژه ها:

Epilepsy ، Infertility ، Catamenial Epilepsy.