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Epilepsy presents unique problems for women

SAN FRANCISCO-- Anti-epileptic drugs (AEDs) are powerful medications that help women with epilepsy control their seizures; however, when these same women have to deal with reproductive issues and their epilepsy drugs, a myriad of problems can crop up, according to Mark Yerby, M.D., MPH, a leading expert in women's issues and epilepsy. About 1 million of the estimated 2.5 million Americans with epilepsy are women.

Dr. Yerby is associate clinical professor of neurology, public health and preventive medicine, and obstetrics and gynecology at the Oregon Health Science University and director of the Epilepsy Program at Providence St. Vincent's Medical Center, both in Portland, Ore. He spoke today at an American Medical Association media briefing in partnership with the American Academy of Neurology (AAN) and the American Epilepsy Society at the AAN's annual meeting in San Francisco.

Hormonal changes may be responsible for some of the specific difficulties encountered by women with epilepsy. Many women find that their seizures change in severity or occur more frequently during puberty, pregnancy, when they are menstruating or during menopause.

"Pregnancy presents particular difficulties for women with epilepsy," Dr. Yerby said. "In pregnancy, drugs are generally contraindicated, but women with epilepsy cannot just simply stop taking their medications. If they do, they may have more seizures and risk injury to themselves and the fetus. They may be subject to other risks, such as losing their jobs or driver's license."

Other adverse outcomes of uncontrolled seizures, Dr. Yerby noted, are fetal loss, infant mortality, decreased growth of the fetus and abnormal cognitive development (increased 2-fold in the children of women with epilepsy).

On the other hand, some AEDs are associated with a higher risk for birth defects. The fear of birth defects can cause women to stop taking their epilepsy medication. "People think drugs are bad--th
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Contact: Jeanne Galatzer-Levy
jeanne_galatzer@ama-assn.org
312-464-5980
American Medical Association
26-Apr-2004


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