Amanda Wilde (Host): [00:00:00] Epilepsy is a complex, often misunderstood condition that affects over 1 million women of childbearing age in the United States. Just ahead, we're discussing how epilepsy affects women and reproductive health with neurologist Dr. Gregory Matthews, who specializes in seizures and epilepsy.

This is Your Best Life Podcast from Holy Cross Health. I'm Amanda Wilde. Dr. Matthews, it's great to have you here today.

Dr Gregory Mathews: Thank you. It's great to be with you.

Host: Well, let's talk about this condition called epilepsy. What exactly is it?

Dr Gregory Mathews: Well, epilepsy is a term for a condition that is the type of situation where people have recurring seizures. And a seizure is a n electrical event in the brain that causes some sort of change in either your perception or your ability to respond, and in some cases, can cause complete loss of consciousness. So, epilepsy [00:01:00] is a broad term that includes all of these different kinds of seizure types, but it specifically means that the person is susceptible to have seizures over the course of their life.

Host: Well, let's talk about the specific ways epilepsy affects women. Are there specific challenges or considerations for managing epilepsy for women?

Dr Gregory Mathews: Well, first of all, I'd like to say that epilepsy affects people of all ages, and affects women and men roughly equally. And there are many different causes of epilepsy, and some of it is just genetic or something that you're born with. And sometimes it's due to injury or a trauma or something's structurally abnormal in your brain. So, there's many kinds of epilepsy. And women have particular challenges with epilepsy, primarily because most people, not all people, but most people get epilepsy earlier in life. And because of that, women have to deal with the challenges [00:02:00] of taking a medication and controlling their seizures. And particularly when they're dealing with the desire to start a family, to get pregnant, women might be affected by their medications in different ways. It might affect their fertility. There might be concerns about the medication's effect on the pregnancy itself or the developing fetus.

And in addition, there are other issues. For instance, women are more prone to bone loss, osteoporosis, and some medications might impact the likelihood of developing that sort of condition. So, there's many ways in which women have to deal with epilepsy in a way that men don't have to.

Host: And then, women have those markers of our reproductive lives, menstruation, pregnancy, menopause. Do those hormonal changes affect women who are prone to epileptic seizures?

Dr Gregory Mathews: So, interesting fact that's been known for some time is that [00:03:00] certain hormones, particularly estrogen, seem to promote or, at least, increase the chance of having a seizure. Now, if you don't have epilepsy, you don't have to worry about estrogen causing a seizure. But if you do have epilepsy, meaning that you're prone to having seizures, when estrogen levels are high, you may be more likely to have a seizure. And the converse is true with progesterone. When progesterone is high, you may be less likely to have a seizure. So, as you might imagine, then, as the estrogen and progesterone levels cycle throughout the month in women who have normal menstrual cycles, the chances of a seizure might vary depending on the time in their cycle.

So, there's a condition called catamenial epilepsy in which women tend to have their seizures pretty predictably at a certain time during their hormonal cycle. But all women will tend [00:04:00] to at least note some increased chance of seizures during certain times of their monthly cycle. And it may also affect their medications. So, hormones and medications can influence each other. So, there can be complex interactions. You asked about pregnancy and menopause. I think each one of those has its own particular considerations. I think probably the pregnancy issue would be the one that we would want to focus on most, because I think that's the issue that comes up most frequently.

Host: Is it safe for a woman with epilepsy to be pregnant?

Dr Gregory Mathews: I should say that there are many misperceptions out there about pregnancy and epilepsy. Not too long ago, in my own professional lifetime, I have heard it said that women who have epilepsy should not bear children. [00:05:00] That might have been due to the misperception that their child will have epilepsy, so you wouldn't want to bring a child into the world if they're going to have epilepsy. Two, medications are bad and medications could affect your child and so, you wouldn't want to become pregnant. These are incorrect and unfortunately have led a lot of women to opt not to start a family because this is what they were told. Nowadays, we know that women with epilepsy, perhaps there's a very slight increased chance of their offspring having epilepsy because there are some genetic predispositions towards epilepsy. But it's a relatively minor thing compared to most other genetic conditions. So, it's really not something that is worth, in my view, being overly concerned about.

The medications issue dates back to the mid 1900s, when there [00:06:00] were only a few seizure medications out there. And yes, some of them did result in birth defects or other negative outcomes during pregnancy. But now, we have many new medications, and many of them we know, from collecting data over years, don't seem to have any negative impact on the developing fetus and the outcomes of pregnancies. So, we can definitely tell women now that it is okay, it is safe, it is perfectly reasonable to start a family.

There are some things I discuss with women, hopefully way beforehand. My practice is to start discussing this early and often with women, even when they're too young to be really thinking about it. I bring up the ideas so that they can understand for the future what's coming, particularly the choice of medicine. We'd want to be on one of the medicines that we know to be safer, and the importance of getting [00:07:00] their seizures controlled so that they don't have seizures complicating their pregnancy.

Host: So, this is one way healthcare providers can support women with epilepsy in family planning decisions and help with adjustments that might be necessary during pregnancy so that mom and baby are both safe. But it is okay to be pregnant, you just need to be working with your doctor, it sounds like.

Dr Gregory Mathews: Absolutely. Because I am a seizure specialist, I will always bring this up with my patients, at least the very first time we meet. But if they are in childbearing years, I make sure to bring it up each time just to sort of say, "Hey, you know, if your plans or your ideas about your future have changed since the last time we met, I just want to bring it up again. If you decide you want to start a family, here's the things that we should be thinking about. Let's kind of keep it out in the open." [00:08:00] And I try to dispel myths, like medicines are bad for your baby, it's just not true, and allows them to, I think, think a little more freely about what they want to do.

Host: I was going to ask you about myths about pregnancy and epilepsy, but you have touched on that. So instead, to wrap up, I'd like to ask if you have anything that is not a myth, but a fact that is little known that you would like people to know more about epilepsy.

Dr Gregory Mathews: Well, I'm going to get back to the point that I was alluding to earlier that, even with education, there are many women who still feel, and maybe it's just a visceral feeling that, "I'm taking this medicine and it could be bad for my baby," and maybe they reduce their dose or skip doses or I've had women try to wean themselves off of their seizure medicine. And the point would be it's much worse to have a seizure when you're pregnant. Every seizure brings with it a risk [00:09:00] of an injury, an accident, a fall. And any one of those is worse for your baby than being on these medicines, especially the ones that we know to be safe.

So, I think the most important thing that women could do for themselves and for their baby is to get their seizures controlled and to keep them controlled throughout their pregnancy. So, I would say that sometimes you're not going to get that kind of advice and knowledge from a regular practitioner, even a neurologist who doesn't specialize in seizures. They may not feel comfortable with this process. So, one of the things you may want to do is look around for a seizure specialist, if you're thinking about starting a family in the next year or two, say "Maybe I need to meet with someone who does this all the time so they can give me some advice." And the best prevention of problems is education and knowledge.

Host: So, controlling [00:10:00] seizures is the key to having a safe pregnancy, and you may want to see a specialist for the most up-to-date medication and planning.

Dr Gregory Mathews: That's right.

Host: Well, Dr. Matthews, thank you so much for this enlightening conversation about epilepsy and how it specifically affects women and family planning.

Dr Gregory Mathews: Well, thank you so much. It was wonderful to be with you today.

Host: That was neurologist, Dr. Gregory Matthews. For more information, visit holycrosshealth.org/maternity. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Amanda Wilde. Thanks for listening. This is Your Best Life Podcast, presented by Holy Cross Health.