| Martha Morrell, M.D., is the Director of the Columbia Comprehensive
Epilepsy Center at New York-Presbyterian Hospital, as well as a Professor
of Clinical Neurology at Columbia University. Dr. Morrell's research has
focused on female reproductive health risks associated with epilepsy. She
is the lead author in a published report entitled, "Health Issues for Women
with Epilepsy: A Descriptive Survey to Assess Knowledge and Awareness Among
Health Care Providers," published in the November 2000 issue of the Journal
of Women's Health and Gender-based Medicine. She is the senior author of
the Expert Consensus Guideline Series: Treatment of Epilepsy, published
as a supplement in November/December 2001 issue of Epilepsy & Behavior.
Dr. Morrell has served as an epilepsy advisor to the National Institutes
of Health (NIH), Centers of Disease Control and Prevention (CDC) and as
a member of the Board of Directors of the American Epilepsy Society. She
is the immediate past chair of the Epilepsy Foundation.
What Some Women Need To Know About Reproductive Health And Certain Medications
Epilepsy has long been misunderstood, often causing people with the disorder
to be stigmatized or to receive inadequate health care. Although we no longer
think that people with epilepsy are possessed by demons as people did in ancient
times, much of the public and many health care providers still don't understand
epilepsy, especially when it comes to the unique way in which it affects women.
More than two million Americans live with epilepsy, about half of whom are
women and girls. Second to headaches, epilepsy is the neurological disorder
seen most often by physicians and one of the most common chronic health conditions
affecting women of reproductive age. Many other women also use anti-epilepsy
drugs (AEDs) to treat conditions such as migraines, pain conditions, and bipolar
disorder. However, little is known about the effect of this treatment as it
relates to females.
Epilepsy is a seizure disorder caused by brief, abnormal discharge of electrical
activity in one's brain. Epilepsy is diagnosed through a combination of medical
tests, a thorough medical history plus discussion with a doctor. Most doctors
diagnose patients as having epilepsy if they have two or more seizures. Among
the many causes are infections, head injuries, brain tumors, brain injuries
at birth, and genetic predisposition. In the majority of people, a cause is
never discovered. Seizures can last a few seconds or several minutes, and symptoms
range from a blank stare to a jerking motion in arms and legs. Because of the
variety of seizure symptoms, epilepsy is often confused with and misdiagnosed
as fainting, migraine, or panic attacks.
Epilepsy in women can be very complicated because it's often hard to distinguish
the effects of the illness from the effects of the medications used to manage
seizures. Women with epilepsy can experience a host of reproductive and sexual
problems, excessive weight gain, and osteoporosis when compared to women in
the general population. Reproductive problems with epilepsy can include difficulties
becoming pregnant and an increased risk of having children with birth defects,
menstrual irregularity, infertility and a condition called polycystic ovarian
syndrome (PCOS), which itself causes infertility, irregular or absent menses,
ovarian cysts, obesity and unwelcome changes in facial and body hair. Further
complicating matters is the fact that the majority of health care professionals
who responded to a recent survey are unaware of the impact of epilepsy and its
treatment on women.
The good news is that recent studies are showing that certain anti-epilepsy
drugs are less likely than others to be related to some of these female-specific
effects. Furthermore, new treatment guidelines have been issued, recognizing
the need for special treatment strategies for groups such as women. These consensus
guidelines, based on the clinical practices of leading epilepsy experts from
around the country, outline a separate treatment strategy for women in their
childbearing years, relying on anti-epilepsy drugs (AEDs) that appear to be
less likely to cause these problems for women.
If you are prescribed AEDs for the treatment of epilepsy or for other reasons,
make sure you and your physician are aware of potential concerns relating to
the use of these medications in females. One source of information is the Epilepsy
Foundation's Women and Epilepsy Initiative launched in 1997 to help women
manage the effects of epilepsy and its treatment in their daily lives.
For more information about epilepsy, click here.
Created: 1/6/2002  - Martha Morrell, M.D.