Epilepsy in women – selected issues
Hanna Podraza1, Monika Białecka2, Barbara Oleksy3
Epilepsy is one of the most frequent diseases of the central nervous system and affects about 50 million people in the world. It is a heterogeneous disease entity associated with various clinical manifestations and coexisting symptoms (such as neurodevelopmental disorders), resulting in different response to medication and different prognosis. Clinical evidence points to the existence of epilepsy and epilepsy syndromes dependent on sex. Female and male sex hormones affect the brain convulsion threshold. Catamenial epilepsy is a well-known example here, in which the neurohormonal mechanisms dependent on the menstrual cycle affect the occurrence of convulsions. Progesterone is an anticonvulsant hormone, while oestrogens can be both pro- and anticonvulsant, depending on the physiological state. Unlike in the case of progesterone, the influence of the potential convulsion threshold modulation of testosterone is complex. In animal models, but also in clinical trials, testosterone intensifies the occurrence of convulsions through its metabolism to oestrogens. The paper presents the effects of antiepileptic drugs on the offspring of mothers with epilepsy (congenital malformations, lower birth weight, and neurodevelopmental disorders). Aggregate data indicate the highest teratogenicity of the exposure to valproic acid and other antiepileptics used in polytherapy. Other factors may also influence foetal development: severity of epilepsy itself, the type of seizures, mother’s intelligence quotient and socioeconomic status as well as the exposure to toxic agents (including alcohol and other stimulants). The optimal selection of antiepileptic drugs should be sought even before the planned pregnancy in the care of women at childbearing age suffering from epilepsy.