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Contraception for Women with Epilepsy

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Abstract

Epilepsy is a chronic condition that is usually managed through antiepileptic drugs (AEDs). An estimated 1 million girls and women in the USA have the disorder. The stigma associated with epilepsy can impact their quality of life, including their romantic and sexual relationships and reproductive decisions. Women with epilepsy (WWE) can use contraception safely and successfully, though difficulties understanding confusing drug-drug interactions and navigating complex health systems can make obtaining appropriate contraceptive care challenging. Nonhormonal methods pose no unique issues for WWE. However, there is potential for bidirectional interactions between AEDs and hormonal contraceptives. AEDs that induce hepatic cytochrome P450 enzymes can reduce hormonal contraceptive effectiveness. Optimal contraceptive methods for women taking enzyme-inducing AEDS include any intrauterine device (IUD) or depot medroxyprogesterone acetate (DMPA, 150 mg). Recommendations for women taking no AED or non-inducing AEDs mirror those for their healthy peers. Estrogenic components of combined methods rapidly lead to large reductions in lamotrigine (LTG) levels. When combined hormonal methods are used, LTG dose adjustment is necessary in consultation with a neurologist to maintain seizure control. Accurate contraceptive guidance promotes both the reproductive and neurological health of WWE.

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References

  1. Fisher R, Acevedo C, Arzimanoglou A, Bogacz A, Cross J, Elger C, et al. An Operational Clinical Definition of Epilepsy [Internet]. International League Against Epilepsy; 2013. http://www.ilae.org/Visitors/Centre/Documents/DefinitionofEpilepsy.pdf.

  2. Institute of Medicine (US) Committee on the Public Health Dimensions of the Epilepsies. Epilepsy across the spectrum: Promoting Health and Understanding [Internet]. In: England MJ, Liverman CT, Schultz AM, Strawbridge LM, editors. Washington, DC: National Academies Press; 2012 [cited 2013 Nov 27]. http://www.ncbi.nlm.nih.gov/books/NBK91506/.

  3. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342(5):314–9.

    Article  CAS  PubMed  Google Scholar 

  4. Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc task force of the ILAE commission on therapeutic strategies. Epilepsia. 2010;51(6):1069–77.

    Article  CAS  PubMed  Google Scholar 

  5. Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R. How common are the “common” neurologic disorders? Neurology. 2007;68(5):326–37.

    Article  CAS  PubMed  Google Scholar 

  6. Hesdorffer DC, Logroscino G, Benn EKT, Katri N, Cascino G, Hauser WA. Estimating risk for developing epilepsy: a population-based study in Rochester, Minnesota. Neurology. 2011;76(1):23–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Pennell PB. Pregnancy, epilepsy, and women’s issues. Continuum (Minneap Minn). 2013;19(3 Epilepsy):697–714.

    Google Scholar 

  8. Morrell MJ, Hayes FJ, Sluss PM, Adams JM, Bhatt M, Ozkara C, et al. Hyperandrogenism, ovulatory dysfunction, and polycystic ovary syndrome with valproate versus lamotrigine. Ann Neurol. 2008;64(2):200–11.

    Article  CAS  PubMed  Google Scholar 

  9. Herzog AG, Klein P, Ransil BJ. Three patterns of catamenial epilepsy. Epilepsia. 1997;38(10):1082–8.

    Article  CAS  PubMed  Google Scholar 

  10. Verrotti A, D’Egidio C, Agostinelli S, Verrotti C, Pavone P. Diagnosis and management of catamenial seizures: a review. Int J Womens Health. 2012;4:535–41.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Herzog AG, Fowler KM, Smithson SD, Kalayjian LA, Heck CN, Sperling MR, et al. Progesterone vs placebo therapy for women with epilepsy: a randomized clinical trial. Neurology. 2012;78(24):1959–66.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Dennis A. Identifying and responding to the reproductive decision-making needs of women with epilepsy. Boston, MA: Boston University School of Public Health; 2012.

    Google Scholar 

  13. Chung K, Liu Y, Ivey SL, Huang D, Chung C, Guo W, et al. Quality of life in epilepsy (QOLIE): insights about epilepsy and support groups from people with epilepsy (San Francisco Bay Area, USA). Epilepsy Behav. 2012;24(2):256–63.

    Article  PubMed  Google Scholar 

  14. Djibuti M, Shakarishvili R. Influence of clinical, demographic, and socioeconomic variables on quality of life in patients with epilepsy: findings from Georgian study. J Neurol Neurosurg Psychiatry. 2003;74(5):570–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Austin JK, Shafer PO, Deering JB. Epilepsy familiarity, knowledge, and perceptions of stigma: report from a survey of adolescents in the general population. Epilepsy Behav. 2002;3(4):368–75.

    Article  PubMed  Google Scholar 

  16. Luef G. Female issues in epilepsy: a critical review. Epilepsy Behav. 2009;15(1):78–82.

    Article  PubMed  Google Scholar 

  17. Elliott JO, Charyton C, Sprangers P, Lu B, Moore JL. The impact of marriage and social support on persons with active epilepsy. Epilepsy Behav. 2011;20(3):533–8.

    Article  PubMed  Google Scholar 

  18. Harden CL. Sexuality in men and women with epilepsy. CNS Spectr. 2006;11(8 Suppl 9):13–8.

    PubMed  Google Scholar 

  19. Crawford P, Hudson S. Understanding the information needs of women with epilepsy at different lifestages: results of the “Ideal World” survey. Seizure. 2003;12(7):502–7.

    Article  CAS  PubMed  Google Scholar 

  20. Pennell PB, Thompson P. Gender-specific psychosocial impact of living with epilepsy. Epilepsy Behav. 2009;15 Suppl 1:S20–5.

    Article  PubMed  Google Scholar 

  21. Gold R, Sonfield A, Richards C, Frost JJ. Next steps for America’s family planning program: Leveraging the potential of Medicaid and Title X in an evolving health care system [Internet]. New York, NY: Guttmacher Institute; 2009. p. 44. http://www.guttmacher.org/pubs/NextSteps.pdf.

  22. Practice parameter: management issues for women with epilepsy (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1998;51(4):944–8.

    Google Scholar 

  23. Davis AR, Pack AM, Kritzer J, Yoon A, Camus A. Reproductive history, sexual behavior and use of contraception in women with epilepsy. Contraception. 2008;77(6):405–9.

    Article  PubMed  Google Scholar 

  24. Long L, Montouris G. Knowledge of women’s issues and epilepsy (KOWIE-II): a survey of health care professionals. Epilepsy Behav. 2005;6(1):90–3.

    Article  PubMed  Google Scholar 

  25. Morrell MJ, Sarto GE, Shafer PO, Borda EA, Herzog A, Callanan M. Health issues for women with epilepsy: a descriptive survey to assess knowledge and awareness among healthcare providers. J Womens Health Gend Based Med. 2000;9(9):959–65.

    Article  CAS  PubMed  Google Scholar 

  26. Pack AM, Davis AR, Kritzer J, Yoon A, Camus A. Antiepileptic drugs: are women aware of interactions with oral contraceptives and potential teratogenicity? Epilepsy Behav. 2009;14(4):640–4.

    Article  PubMed  Google Scholar 

  27. Vessey M, Painter R, Yeates D. Oral contraception and epilepsy: findings in a large cohort study. Contraception. 2002;66(2):77–9.

    Article  PubMed  Google Scholar 

  28. Meador KJ, Penovich P, Baker GA, Pennell PB, Bromfield E, Pack A, et al. Antiepileptic drug use in women of childbearing age. Epilepsy Behav. 2009;15(3):339–43.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Dutton C, Foldvary-Schaefer N. Contraception in women with epilepsy: pharmacokinetic interactions, contraceptive options, and management. Int Rev Neurobiol. 2008;83:113–34.

    Article  PubMed  Google Scholar 

  30. Christensen J, Petrenaite V, Atterman J, SidenIUD P, Ohman I, Tomson T, et al. Oral contraceptives induce lamotrigine metabolism: evidence from a double-blind, placebo-controlled trial. Epilepsia. 2007;48(3):484–9.

    Article  CAS  PubMed  Google Scholar 

  31. Sabers A, Buchholt JM, Uldall P, Hansen EL. Lamotrigine plasma levels reduced by oral contraceptives. Epilepsy Res. 2001;47(1–2):151–4.

    Article  CAS  PubMed  Google Scholar 

  32. Sabers A, Ohman I, Christensen J, Tomson T. Oral contraceptives reduce lamotrigine plasma levels. Neurology. 2003;61(4):570–1.

    Article  CAS  PubMed  Google Scholar 

  33. Reimers A, Helde G, Brodtkorb E. Ethinyl estradiol, not progestogens, reduces lamotrigine serum concentrations. Epilepsia. 2005;46(9):1414–7.

    Article  CAS  PubMed  Google Scholar 

  34. Davis AR, Westhoff CL, Stanczyk FZ. Carbamazepine coadministration with an oral contraceptive: effects on steroid pharmacokinetics, ovulation, and bleeding. Epilepsia. 2011;52(2):243–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  35. Sidhu J, Job S, Singh S, Philipson R. The pharmacokinetic and pharmacodynamic consequences of the co-administration of lamotrigine and a combined oral contraceptive in healthy female subjects. Br J Clin Pharmacol. 2006;61(2):191–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Contin M, Albani F, Ambrosetto G, Avoni P, Bisulli F, Riva R, et al. Variation in lamotrigine plasma concentrations with hormonal contraceptive monthly cycles in patients with epilepsy. Epilepsia. 2006;47(9):1573–5.

    Article  CAS  PubMed  Google Scholar 

  37. Rosenfeld WE, Doose DR, Walker SA, Nayak RK. Effect of topiramate on the pharmacokinetics of an oral contraceptive containing norethindrone and ethinyl estradiol in patients with epilepsy. Epilepsia. 1997;38(3):317–23.

    Article  CAS  PubMed  Google Scholar 

  38. Doose DR, Wang S-S, Padmanabhan M, Schwabe S, Jacobs D, Bialer M. Effect of topiramate or carbamazepine on the pharmacokinetics of an oral contraceptive containing norethindrone and ethinyl estradiol in healthy obese and nonobese female subjects. Epilepsia. 2003;44(4):540–9.

    Article  CAS  PubMed  Google Scholar 

  39. Bounds W, Guillebaud J. Observational series on women using the contraceptive Mirena concurrently with anti-epileptic and other enzyme-inducing drugs. J Fam Plann Reprod Health Care. 2002;28(2):78–80.

    Article  PubMed  Google Scholar 

  40. Ohman I, Luef G, Tomson T. Effects of pregnancy and contraception on lamotrigine disposition: new insights through analysis of lamotrigine metabolites. Seizure. 2008;17(2):199–202.

    Article  PubMed  Google Scholar 

  41. Mark AS, Hricak H. Intrauterine contraceptive devices: MR imaging. Radiology. 1987;162(2):311–4.

    Article  CAS  PubMed  Google Scholar 

  42. Zieman M, Kanal E. Copper T 380A IUD and magnetic resonance imaging. Contraception. 2007;75(2):93–5.

    Article  CAS  PubMed  Google Scholar 

  43. Berger-Kulemann V, Einspieler H, Hachemian N, Prayer D, Trattnig S, Weber M, et al. Magnetic field interactions of copper-containing intrauterine devices in 3.0-Tesla magnetic resonance imaging: in vivo study. Korean J Radiol. 2013;14(3):416–22.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Hess T, Stepanow B, Knopp MV. Safety of intrauterine contraceptive devices during MR imaging. Eur Radiol. 1996;6(1):66–8.

    Article  CAS  PubMed  Google Scholar 

  45. Federal Drug Administration. Label information: Paragard [Internet]. Washington (DC): Federal Drug Administration; 2013. http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/018680s066lbl.pdf.

  46. Federal Drug Administration. Package insert: Mirena [Internet]. Washington (DC): Federal Drug Administration; 2013. http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021225s032lbl.pdf.

  47. Federal Drug Administration. Package insert: Skyla [Internet]. Washington (DC): Federal Drug Administration; 2013. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#labelinfo.

  48. Haukkamaa M. Contraception by Norplant subdermal capsules is not reliable in epileptic patients on anticonvulsant treatment. Contraception. 1986;33(6):559–65.

    Article  CAS  PubMed  Google Scholar 

  49. Schindlbeck C, Janni W, Friese K. Failure of Implanon contraception in a patient taking carbamazepin for epilepsia. Arch Gynecol Obstet. 2006;273(4):255–6.

    Article  PubMed  Google Scholar 

  50. Kenyon IE. Unplanned pregnancy in an epileptic. Br Med J. 1972;1(5801):686–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  51. Mattson RH, Cramer JA, Caldwell BV, Siconolfi BC. Treatment of seizures with medroxyprogesterone acetate: preliminary report. Neurology. 1984;34(9):1255–8.

    Article  CAS  PubMed  Google Scholar 

  52. Kaunitz AM, Arias R, McClung M. Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception. 2008;77(2):67–76.

    Article  CAS  PubMed  Google Scholar 

  53. Pack AM. Treatment of epilepsy to optimize bone health. Curr Treat Options Neurol. 2011;13(4):346–54.

    Article  PubMed  Google Scholar 

  54. Federal Drug Administration. Label information: Essure [Internet]. Washington (DC): Federal Drug Administration; 2002. http://www.accessdata.fda.gov/cdrh_docs/pdf2/P020014c.pdf.

  55. Kevles DJ. In the name of eugenics: genetics and the uses of human heredity. Cambridge, MA: Harvard University Press; 1985. p. 448.

    Google Scholar 

  56. Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, et al. Practice parameter update: management issues for women with epilepsy–focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73(2):142–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 2013;12(3):244–52.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. EURAP Study Group. Seizure control and treatment in pregnancy: observations from the EURAP epilepsy pregnancy registry. Neurology. 2006;66(3):354–60.

    Article  Google Scholar 

  59. Battino D, Tomson T, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia. 2013;54(9):1621–7.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA

    Anne R. Davis M.D., M.P.H.

  2. Department of Neurology, Columbia University Medical Center, New York, NY, USA

    Alison M. Pack M.D., M.P.H.

  3. Ibis Reproductive Health, Cambridge, MA, USA

    Amanda Dennis Dr.P.H., M.B.E.

Authors
  1. Anne R. Davis M.D., M.P.H.
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  2. Alison M. Pack M.D., M.P.H.
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  3. Amanda Dennis Dr.P.H., M.B.E.
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Corresponding author

Correspondence to Anne R. Davis M.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

    Rebecca H. Allen

  2. Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA

    Carrie A. Cwiak

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Davis, A.R., Pack, A.M., Dennis, A. (2014). Contraception for Women with Epilepsy. In: Allen, R., Cwiak, C. (eds) Contraception for the Medically Challenging Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1233-9_8

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  • DOI: https://doi.org/10.1007/978-1-4939-1233-9_8

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