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Anti-Epileptic Drugs and Hormonal Treatments

  • Clare A. JohnstonEmail author
  • Pamela M. Crawford
EPILEPSY (E WATERHOUSE, SECTION EDITOR)
Part of the following topical collections:
  1. Topical Collection on Epilepsy

Opinion statement

Epilepsy and the medications used in its treatment are known to affect the menstrual cycle, aspects of contraception, and bone health in women. Adolescence is an important time to review the diagnosis of both epilepsy and the epilepsy syndrome because of the implications and decisions, which should be made regarding antiepileptic drug (AED) treatment. In girls, once they are on AED therapy, seizure free, and driving, it becomes difficult to change therapy because of the risk of breakthrough seizures and the fact that the new AED may not be as effective as the first. So a treatment choice made in adolescence is often life-long. Therefore, women need to be started on an AED that currently appears to be the most suitable for their seizure type, has a low teratogenic risk, and hopefully does not interact with contraception. There are no contraindications to the use of non-hormonal methods of contraception in women with epilepsy. Nonenzyme-inducing AEDs (valproate, benzodiazepines, ethosuximide, levetiracetam, tiagabine, and zonisamide) do not show any interactions with the combined oral contraceptive. There are interactions between the combined oral contraceptive and hepatic microsomal-inducing AEDs (phenytoin, barbiturates, carbamazepine, topiramate [dosages >200 mg/day], oxcarbazepine, eslicarbazepine and perampanel [dosages >12 mg/day]) and lamotrigine. Women taking enzyme inducing AEDs should be encouraged to use a method of contraception that is unaffected by their epilepsy medication. Interactions between AEDs and other hormonal therapies are less well studied. Studies have suggested that women with epilepsy are at increased risk of fractures, osteoporosis, and osteomalacia. No studies have been undertaken looking at preventative therapies for these comorbidities. This article will concentrate on current contraceptive treatment options in patients taking AEDs.

Keywords

Epilepsy Anti-epileptic drugs Phenobarbitone Phenytoin Sodium valproate Lamotrigine Carbamazepine Oxcarbazepine Eslicarbazepine Gabapentin Pregabalin Tiagabine Topiramate Zonisamide Benzodiazepines Ethosuximide Perampanel Hormones Contraception Oral contraceptive pill Medroxyprogesterone Norethisterone Levonorgestrel implants Intra-uterine contraceptive device Contraceptive implant 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Clare A. Johnston has had travel/accommodations expenses covered/reimbursed by Pfizer. Pamela M. Crawford has had travel/accommodations expenses covered/reimbursed by UCB and Eisai.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.The York HospitalYorkUK

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