Women epilepsy

Bauer J, Jarre A, Khngmuller D, Eiger CE. Polycystic ovary syndrome in patients with focal epilepsy a study in 93 women. Epilepsy Res 2000 41(2) 163-7. 

The rate of completed suicides in the general population is 12.0/100 000 [24 ], with a marked predominance in men [25 ], while the lifetime prevalence of suicide attempts is 0.6-4.9% overall [26 ], with a preponderance in women. Epilepsy is co-morbid with suicidality [27 ] and with major depression [28P]. After a diagnosis of epilepsy, the risk of completed suicide increases the overall standardized mortality ratio ranges from 3.5 to 5.0 and is higher in the presence of a known psychiatric diagnosis [29 "]. In addition, suicidal ideation and behavior have been identified as psychiatric phenomena in patients with drug-resistant epilepsy [30 "]. 

BC, a 22-year-old woman, was diagnosed 2 years ago with juvenile myoclonic epilepsy. She has been treated with valproate 1500 mg/day. Since starting valproate she has gained 45 pounds (20.5 kg), continues to have occasional myoclonic jerks, had a generalized tonic-clonic seizure 3 months ago, and is sexually active. Additionally, she complains of easily falling asleep during the day. Due to adverse effects, poor seizure control, and the risk of birth defects with valproate, the decision is made to switch to a different antiepileptic drug. 

A 27-year-o d woman with epilepsy has been taking phenytoin to control her seizures. She is now pregnant, and her physician is considering changing her medication to prevent potential bleeding episodes in the in nt. What biochemical activity might be deficient in the infant if her medication is continued ... 

In dealing with the clinical problem of a pregnant woman with epilepsy, most epileptologists agree that although it is important to minimize... 

A 72-year-old woman taking valproate as monotherapy for her epilepsy developed a urinary tract infection and was given pivmecillinam 600 mg/day. During the next few days she became stuporose her serum ammonia concentration was high (113 mmol/1) but liver function was normal. Pivmecillinam and valproate were withdrawn and she recovered rapidly. 

A 50-year-old woman with an electroencephalographic abnormality but no history of epilepsy, who had taken amitriptyline and perphenazine uneventfully for years, suffered two seizures 18 days after switching to trazodone 50 mg/day. 

A proconvulsive effect of lithium was also suggested in two patients purported to have temporal lobe epilepsy, who improved when carbamazepine replaced lithium (149). Twelve cases of status dystonicus of varying causes included a woman with post-traumatic dystonia, who was treated unsuccessfully with lithium. Despite the lack of response, her muscular spasms worsened when lithium was stopped (184). 

A 35-year-old woman with epilepsy without a history of psychiatric disorders developed elevated mood after being stabilized on gabapentin monotherapy (3200 mg/ day). After 5 months she developed a manic episode, which remitted when gabapentin was withdrawn. 

Complex visual hallucinations occurred in three patients taking zonisamide for different syndromes and types of seizures (Landau-Kleffner syndrome in a 7-year-old girl, myoclonic and generalized tonic seizures in a 21-year-old woman, and partial epilepsy in a 13-year-old girl) (692). None of the patients had visual hallucinations before zonisamide was started, and the symptoms resolved after withdrawal. 

A 39-year-old woman developed a dystonic reaction (masseter spasm, lip smacking, oculogyric crisis, and mild neck spasm) within 5 minutes of intravenous administration of cimetidine 300 mg for epigastric pain. She had epilepsy and had not taken her antiepileptic medication regularly. She had developed a similar dystonic reaction to prochlorperazine 1 week before. She recovered within 5 minutes of treatment with intravenous diphenhydramine and lorazepam. 

A 78-year-old man and an 84-year-old woman with previously well-controlled epilepsy presented with recurrent seizures (4). There were no obvious reasons for these events, and the investigator suspected self-medication with G. biloba extracts. Both patients had started taking G. biloba within 2 weeks of the start of the seizures. The herbal remedy was withdrawn and both patients remained seizure-free several months later. No other change of medication was made. 

A 36-year-old woman, without any past or family history of epilepsy, developed frequent vomiting and generalized convulsions about 4 hours after taking about 70-80 ginkgo nuts, seeds of G. biloba, in an attempt to improve her health (16). 

A 45-year-old woman with a history of epilepsy developed a lumbosacral acute demyelinating polyneuropathy 1 month after her second hepatitis B immunization (22). She had an uncommon syndrome that combined demyelinating and axonal features confined to the lumbosacral roots whose relation to GuiUain-Barre syndrome was unclear. Viral or bacterial causes of the disease could not be found. 

A 55-year-old woman taking lamotrigine and valproate for partial epilepsy took an overdose of lamotrigine and... 

In a 50-year-old woman with familial hjrpercholesterol-emia and epilepsy, the addition of phenytoin caused a marked reduction in the lipid response to atorvastatin, an effect that was reversible after withdrawal of the anticonvulsant (69). It is likely that phenytoin reduced the efficacy of atorvastatin by inducing its metabolism. 

Cisplatin caused subtherapeutic carbamazepine and valproic acid concentrations in a 38-year-old woman with epilepsy undergoing cytotoxic cancer chemotherapy with doxorubicin and cisplatin, resulting in tonic-clonic seizures the mechanism was not clear (266). 

After an increase in tiagabine dose to 32 mg/day, a 28-year-old woman with partial epilepsy developed a prolonged and disoriented state associated with generalized spike-and-wave discharges on the electroencephalogram. Tiagabine was withdrawn and the status did not recur. 

An 18-year-old woman also developed leg edema while taking valproate 800 mg/day for epilepsy (53). Although she had taken valproate for 10 years without edema, the lack of alternative explanations and the disappearance of the condition after withdrawal suggested a drug-related effect. She also had dysmenorrhea, hirsutism, and obesity, which were thought to have been caused by valproate. 

KM is a 20-year-old woman with a history of epilepsy and scoliosis. Her seizures have been controlled on a maintenance dosage of divalproex sodium. She is scheduled to undergo a spinal fusion, and will not be taking anything by mouth (NPO) for several days. Which factor should be taken into consideration for her postsurgical care ... 

Similar to this patient. Summers et al. describe the case of a 24-year-old woman suffering from intractable epilepsy, who also profited from verapamil coadministration [52]. These findings suggest that despite the fact that most AEDs seem to be poor ABCBl substrates, verapamil can help increase AED concentration in epileptogenic tissues and thus can alleviate RE. It has to be noted, however, that verapamil is not a specific inhibitor of ABCBl and may rather alter the properties of the BBB (i.e., tight junctions) by blocking Ca -channels, thus enabling paracellular influx of AEDs into the brain. The exact mechanism of how verapamil enables AED treatment of RE remains to be elucidated. 

The antiseizure drugs introduced after 1990 have teratogenic effects in animals but whether such effects occur in humans is uncertain. One consideration for a woman with epilepsy who wishes to become pregnant is a trial period without antiseizure medication monotherapy with careful attention to drug levels is another alternative. Polytherapy with toxic levels should be avoided. Folate supplementation (0.4 mg/day) is recommended for all women of childbearing age to reduce the likelihood of neural tube defects, and this is appropriate for epileptic women as well. 

There is a report of hyperammonaemic encephalopathy which developed in a 72-year-old woman taking valproate monotherapy for partial epilepsy after she started treatment with pivmecillinam 600 mg daily. She recovered after discontinuation of valproate and use of cefuroxime instead of pivmecillinam. Valproate may reduce serum carnitine, for reasons that are not well understood. Valproate-induced hyperammonaemic encephalopathy may be due to reduced carnitine levels. ... 

A woman whose epilepsy was controlled with sodium vaiproate developed convulsions when she took mefloquine. Note that mefloquine is normally contraindicated in epilepsy. 

An isolated report deseribes a 20-year-old woman, with a 7-year history of epilepsy (bilateral myoelonus and generalised tonic-clonic seizures) controlled with sodium valproate 1.3 g daily, who developed tonic-clonic seizures 8 hours after taking the second of 3 prophylactic doses of mefloquine 250 mg. It is not clear whether this resulted from a drug-drug or a drug-disease interaction. The manufacturers of mefloquine advise its avoidance in those with a history of convulsions as it may increase the risk of convulsions. In these patients mefloquine should he used only for curative treatment if compelling reasons exist. ... 

An isolated report describes a 26-year-old woman with cerebral palsy who had been taking phenobarbital 15 mg with carbamazepine 400 mg daily for 12 years to control epilepsy, and who developed fatal toxic epidermal necrolysis 2 weeks after starting oral terbinafine 250 mg daily for tinea corporis. The reasons are not understood, but the authors point out that all three drugs can cause adverse skin reactions (erythema multiforme) and suggest that some synergism may have occurred. It is uncertain whether this was a true interaction or a terbinafine adverse effect. 

A 30-year-old woman taking nevirapine, saquinavir 1.2 g daily and ritonavir 600 mg daily with undeteetable viral load had her epilepsy med-ieation ehanged from gabapentin and lorazepam to lamotrigine and phenytoin beeause of inereased frequeney and severity of seizures. She required phenytoin 8 mg/kg daily to maintain therapeutie serum levels. The ritonavir dose was doubled and the saquinavir dose inereased to 2 g daily to eompensate for the enzyme-indueing efifeets of phenytoin. The patient s viral load remained undeteetable, and her seizures deereased over the next 6 months but she died suddenly of unexplained causes following a tonic-elonie seizure (autopsy not performed). ... 

In a pharmacokinetic study, sodium valproate 200 mg twice daily had no effect on the AUC of a single dose of a combined oral contraceptive (ethi-nylestradiol/levonorgestrel 50/250 micrograms) given to women with epilepsy 8 to 16 weeks after they started sodium valproate. However, a 50% increase in the peak plasma levels of ethinylestradiol was noted. Conversely, one pregnancy was identified in a woman who took sodium valproate and an oral contraceptive (unspecified) in the adverse reactions... 

Hematologic A 45-year-old woman with epilepsy developed leukopenia and thrombocytopenia during treatment with pheno-barbital + lamotrigine [186" ]. 

Liver A 58-year-old woman with epilepsy developed a significant increase in gamma-glutamyltransferase activity while taking levetiracetam monotherapy [215 ]. Levetiracetam was progressively withdrawn and replaced with lamotrigine 200 mg/day, and over the next 2 months, the yGT activity gradually fell. 

---