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Women’s Issues
Birth Control

  It is possible to prescribe the contraceptive pill. However there are several antiepileptic medications, which have interactions with the "pill". One may either change the contraception method or change the antiepileptic treatment. Your doctor will help you.

  Oral contraceptives ‘efficacy is impaired by concomitant use of enzyme-inducing AEDs (medication that causes the liver to increase metabolism of other medication) such as phenytoin, carbamazepine, barbiturates, and topiramate.

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  The non-enzyme-inducing AEDs, such as Lamotrigine, valproic acid, clobazam, vigabatrin, and gabapentin, do not reduce levels of OC hormones, therefore should not increase the risk for OC failure.

  If on an enzyme -inducing AED consider choosing an OC with estrogen content 50 micrograms although this does not guarantee efficacy. A clue to the possibility that the OC pill may not be effective is breakthrough mid-cycle bleeding. The lack of breakthrough bleeding does not however  guarantee OC effectiveness if on an enzyme inducing AED.

    The progesterone -only contraceptive may also be less effective in women receiving liver enzyme-inducing AEDs.

 

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Pregnancy.

  If possible prior to conception, one will try to decrease the dose of medication to the lowest level possible. Vitamin supplementation and in particular Folic Acid supplementation should be taken. Ultra Sonographic monitoring of the pregnancy is highly recommended, blood pressure of the mother will be monitored as well. The pregnancy may affect the seizures either way, increasing or decreasing their frequency. The delivery should be well planned to avoid seizure during labor. Breathing exercises may need to be limited. Otherwise no other limitation, for example peridural anaesthesia is perfectly acceptable.

 

The Newborn  
    It is recommended to have a pediatrician at the birth. The infant may be sedated by the antiepileptic medication, and later the baby may become irritable due to withdrawal. Breast feeding is not contra-indicated and the epileptic mother can breast feed her child regardless of the antiepileptic medication that she is taking. There are some risks of medication-induced malformations to the fetus. These risks can be minimized by planning and monitoring the pregnancy. The genetic risks for the child to develop an epileptic problem depend on the type of epilepsy the mother has. You should discuss your individual case with your doctor.