2014
American Epilepsy Society Poster (Abst. 2.230)
Epilepsy and reproductive issues in women with epilepsy: survey of an unselected community of women with epilepsy
Authors: Olgica Laban-Grant, Evan Fertig, Munazza Malik, Corazon de la Pena, Melissa Fleming, M. Lancman, Pavel Klein and Marcelo Lancman
Rationale:
Optimal treatment of women with epilepsy (WWE) requires understanding of both current practices and knowledge of women with epilepsy, and understanding the possible association between different types of epilepsy and health issues in women with epilepsy. Previous studies in this area have evaluated largely WWE at tertiary academic epilepsy centers specializing in treatment of WWE, with potential patient selection bias. The aim of this study is to evaluate self-reported issues in unselected women with epilepsy evaluated in the community.
Methods:
Comprehensive questionnaire about women related health issues was systematically given to women with epilepsy ages 12 years and older in our practice. The questionnaire consisted of 31 questions addressing issues of association of seizures with menstruation, pregnancy, menopause and contraception, and reproductive outcomes of these reproductive states. Information about epilepsy was obtained from medical records.
Results:
Ninety-one women completed the questionnaire, 59 women with diagnosis of partial epilepsy, 17 with diagnosis of generalized epilepsy, 5 women with diagnosis of psychogenic non-epileptic seizures (PNES), and 10 women with undefined type of epilepsy or combination of PNES and epilepsy. Twenty-four subjects reported the association of frequency of seizures with menstrual period (39%). Of nine women in menopause three reported a change in seizure pattern, while four noticed no change. Four women underwent fertility treatment, one of which reported a change in seizure pattern during the treatment. Eight women reported change in seizure pattern during pregnancy (17%). Of 124 pregnancies 20 resulted in miscarriages, and 75 in live births. Twenty-one women had at least one cesarean section (45%). Health problems were reported in 11 children (15%). We found no statistical differences between women with generalized vs. partial epilepsy regarding the reported regularity of menstrual periods, presence of association of menstrual cycle and seizure frequency, number of women who had live birth, number of pregnancies or number of women that delivered via C-section. Number of pregnancies that resulted in miscarriage was significantly higher in women with generalized epilepsy (partial 12/105 vs. generalized 8/24, Chisquared 5.581, p=0.018), however no significant difference was found in the number of women who had at least one miscarriage.
Conclusions:
We found that the number of women who delivered via C-section was higher than expected in the general population, as previously reported. The number of miscarriages was higher in population of women with generalized epilepsy although this may be the result of sample size as it was not present in number of women who had at least one miscarriage. Systematic survey of women's issues may provide significant insight in the knowledge and practices of specific population, and is crucial in identifying areas for further education effort and research.