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Managing Epilepsy/Seizures in Women of Reproductive Age
Dr. Sally Mathias shares how common epilepsy is in women of reproductive age group, and treatment options available.
Featured Speaker:
Sally Mathias, MD
Sally Mathias, MD Clinical Interests include Epilepsy, Neurophysiology, Movement Disorders and Vascular Neurology. Transcription:
Managing Epilepsy/Seizures in Women of Reproductive Age
Intro: Another informational resource from UK Healthcare. This is UK HealthCast featuring conversations with our physicians and other healthcare providers.
Caitlin Whyte: Welcome to UK HealthCast from the University of Kentucky Healthcare. I'm your host, Caitlin Whyte. Today, we are discussing managing epilepsy and seizures in women of reproductive age. Joining us is Dr. Sally Mathias, a neurologist with UK Health. So doctor, we're talking about epilepsy today. How common is this in women of a reproductive age?
Sally Mathias, MD: Very common actually. Nearly 1.5 million women of childbearing age in the US live with epilepsy. And each year, approximately 24,000 women with epilepsy give birth.
Caitlin Whyte: Can you walk us through the management of epilepsy and seizures for these women?
Sally Mathias, MD: Sure. I would start off by saying the most important thing is planning a pregnancy and I would divide this into three probably most important points. First is seizure control. Now, the American Academy of Neurology and the American Epilepsy Society practice guidelines state that seizure freedom for at least nine months prior to becoming pregnant is associated with a high likelihood almost 92% of remaining seizure-free during pregnancy. So I emphasize this to the patients and I say that our goal is to get you, you know, seizure-free or reduce the burden of your seizures before you get pregnant, because that determines what happens during pregnancy.
Then the second aspect of this is medication safety. Now, one thing that I tell women who come to me for preconception counseling is you have to be on a safe anti-seizure medicine. And when I say safe, it is relatively safe. All anti-seizure medicines have a slightly higher likelihood of birth defects in the baby. But among the ones that we have, we have to choose medications that are relatively safe. So one thing is what we do is try to make sure the patients are on a relatively safe anti-seizure meds. And second, if they have been seizure-free for a while, then try to reduce the medication burden if they are on many medications and we try to cut down some of them or at least get the doses low so that it is relatively safe. So that's the second point.
And the third point and the most important point, because so many pregnancies happen unplanned is the use of folic acid. And I make it a point to counsel all of my patients of reproductive age groups, starting 11, 12, young girls saying that you have to be on folic acid because folic acid will reduce the chances of neural tube defects. So these are birth malformations of the brain and spinal cord, number one. And, number two, a most recent study has shown that supplementation of folic acid is actually associated with a higher IQ in children at age three and six. So there are so many reasons to be on folic acid. And so that's the third point of the pre-pregnancy counseling or the planning of pregnancy that I do with my patients.
Caitlin Whyte: And what about followups? How frequent should those happen?
Sally Mathias, MD: Well, you know, actually during pregnancy, we usually see patients every four weeks or every month. And the reason for that is while a woman is pregnant, the body is going through so many changes. Mainly, you know, the volume of the blood expand, the kidneys work a lot to increase the clearance of medications. So what happens to the anti-seizure medication levels is that they fall during pregnancy and that's the most common cause for breakthrough seizures during pregnancy. Therefore, you know, the recommendation is to check the levels of anti-seizure medication every four weeks and adjust the dose. And hence, you know, the followups during pregnancy are like every month. And then after they deliver, we space out the followups to, you know, what they were before they got pregnant.
Caitlin Whyte: Could you lay out some parenting basics for us, including breastfeeding and caring for the newborn?
Sally Mathias, MD: Sure. You know, this aspect is so important and there is so much misinformation about breastfeeding in particular. So, you know, actually breastfeeding is safe and recommended with almost every anti-seizure medication. There is only one main exception and that's benzodiazepines. When my patients are on medications like clobazam, clonazepam, lorazepam, you know, that family of medications, I usually tell them not to breastfeed because then it can lead to some sleepiness in the baby. But every other medication, actually the amount of medication that goes through the breast milk to the baby is far less compared to what the baby is exposed to when the baby is in utero. And therefore, I tell the mom, if you want to breastfeed, go ahead. You know, you should be able to do so. So that's about breastfeeding.
Now, the other parenting or childcare rules, I would say, the one rule that I'm very strict about is a mom or even, in this case, a dad with epilepsy not give their newborn baby a submerged bath, that's one rule that I'm very strict about. And the main reason is very little water is enough to drown the baby. And hence I say, you know, until the baby is able to sit by himself or herself, try not to give a submerged bath.
The other simple things are changing the baby on a lower surface, such as a carpeted floor instead of a high diaper changing station, you know, avoiding stairs, avoiding front or back carriers if patients have very frequent seizures. But otherwise, most women, you know, get through this postpartum period really well.
One other important thing is sleep deprivation. It is so natural after having a newborn and sleep deprivation in fact is one of the triggers for seizures. I advise my patients to seek support from their significant others, from their family members, so that they can get some help at night with the baby, so that they can have an uninterrupted sleep for a few hours.
Caitlin Whyte: And as we wrap up here, would you say that epilepsy or seizures are something that with the help of a place like UK Healthcare can be managed by women wanting to become pregnant?
Sally Mathias, MD: Absolutely. Yes. My colleagues and I here in the epilepsy division at UK have been following young women with epilepsy, guiding them through pregnancy and postpartum period for years now. And we get several referrals from practices within Kentucky, including UK OB-GYN. One of our neurologists actually goes to the OB clinic at Maxwell Street to see pregnant women with neurological problem. And our goal is to soon build a dedicated pregnant women's epilepsy program. And so, yes, we are very well-equipped and we have been doing this so UK Healthcare can provide optimal care for young women planning a pregnancy,
Caitlin Whyte: And that wraps up another episode of UK HealthCast with the University of Kentucky Healthcare. UK Healthcare offers the best and most advanced care for our epilepsy patients. Find out more on our website, ukhealthcare.uky.edu. Please remember to subscribe, rate and review this podcast and all the other University of Kentucky Healthcare podcasts. I'm Caitlin Whyte. Thanks for listening.
Managing Epilepsy/Seizures in Women of Reproductive Age
Intro: Another informational resource from UK Healthcare. This is UK HealthCast featuring conversations with our physicians and other healthcare providers.
Caitlin Whyte: Welcome to UK HealthCast from the University of Kentucky Healthcare. I'm your host, Caitlin Whyte. Today, we are discussing managing epilepsy and seizures in women of reproductive age. Joining us is Dr. Sally Mathias, a neurologist with UK Health. So doctor, we're talking about epilepsy today. How common is this in women of a reproductive age?
Sally Mathias, MD: Very common actually. Nearly 1.5 million women of childbearing age in the US live with epilepsy. And each year, approximately 24,000 women with epilepsy give birth.
Caitlin Whyte: Can you walk us through the management of epilepsy and seizures for these women?
Sally Mathias, MD: Sure. I would start off by saying the most important thing is planning a pregnancy and I would divide this into three probably most important points. First is seizure control. Now, the American Academy of Neurology and the American Epilepsy Society practice guidelines state that seizure freedom for at least nine months prior to becoming pregnant is associated with a high likelihood almost 92% of remaining seizure-free during pregnancy. So I emphasize this to the patients and I say that our goal is to get you, you know, seizure-free or reduce the burden of your seizures before you get pregnant, because that determines what happens during pregnancy.
Then the second aspect of this is medication safety. Now, one thing that I tell women who come to me for preconception counseling is you have to be on a safe anti-seizure medicine. And when I say safe, it is relatively safe. All anti-seizure medicines have a slightly higher likelihood of birth defects in the baby. But among the ones that we have, we have to choose medications that are relatively safe. So one thing is what we do is try to make sure the patients are on a relatively safe anti-seizure meds. And second, if they have been seizure-free for a while, then try to reduce the medication burden if they are on many medications and we try to cut down some of them or at least get the doses low so that it is relatively safe. So that's the second point.
And the third point and the most important point, because so many pregnancies happen unplanned is the use of folic acid. And I make it a point to counsel all of my patients of reproductive age groups, starting 11, 12, young girls saying that you have to be on folic acid because folic acid will reduce the chances of neural tube defects. So these are birth malformations of the brain and spinal cord, number one. And, number two, a most recent study has shown that supplementation of folic acid is actually associated with a higher IQ in children at age three and six. So there are so many reasons to be on folic acid. And so that's the third point of the pre-pregnancy counseling or the planning of pregnancy that I do with my patients.
Caitlin Whyte: And what about followups? How frequent should those happen?
Sally Mathias, MD: Well, you know, actually during pregnancy, we usually see patients every four weeks or every month. And the reason for that is while a woman is pregnant, the body is going through so many changes. Mainly, you know, the volume of the blood expand, the kidneys work a lot to increase the clearance of medications. So what happens to the anti-seizure medication levels is that they fall during pregnancy and that's the most common cause for breakthrough seizures during pregnancy. Therefore, you know, the recommendation is to check the levels of anti-seizure medication every four weeks and adjust the dose. And hence, you know, the followups during pregnancy are like every month. And then after they deliver, we space out the followups to, you know, what they were before they got pregnant.
Caitlin Whyte: Could you lay out some parenting basics for us, including breastfeeding and caring for the newborn?
Sally Mathias, MD: Sure. You know, this aspect is so important and there is so much misinformation about breastfeeding in particular. So, you know, actually breastfeeding is safe and recommended with almost every anti-seizure medication. There is only one main exception and that's benzodiazepines. When my patients are on medications like clobazam, clonazepam, lorazepam, you know, that family of medications, I usually tell them not to breastfeed because then it can lead to some sleepiness in the baby. But every other medication, actually the amount of medication that goes through the breast milk to the baby is far less compared to what the baby is exposed to when the baby is in utero. And therefore, I tell the mom, if you want to breastfeed, go ahead. You know, you should be able to do so. So that's about breastfeeding.
Now, the other parenting or childcare rules, I would say, the one rule that I'm very strict about is a mom or even, in this case, a dad with epilepsy not give their newborn baby a submerged bath, that's one rule that I'm very strict about. And the main reason is very little water is enough to drown the baby. And hence I say, you know, until the baby is able to sit by himself or herself, try not to give a submerged bath.
The other simple things are changing the baby on a lower surface, such as a carpeted floor instead of a high diaper changing station, you know, avoiding stairs, avoiding front or back carriers if patients have very frequent seizures. But otherwise, most women, you know, get through this postpartum period really well.
One other important thing is sleep deprivation. It is so natural after having a newborn and sleep deprivation in fact is one of the triggers for seizures. I advise my patients to seek support from their significant others, from their family members, so that they can get some help at night with the baby, so that they can have an uninterrupted sleep for a few hours.
Caitlin Whyte: And as we wrap up here, would you say that epilepsy or seizures are something that with the help of a place like UK Healthcare can be managed by women wanting to become pregnant?
Sally Mathias, MD: Absolutely. Yes. My colleagues and I here in the epilepsy division at UK have been following young women with epilepsy, guiding them through pregnancy and postpartum period for years now. And we get several referrals from practices within Kentucky, including UK OB-GYN. One of our neurologists actually goes to the OB clinic at Maxwell Street to see pregnant women with neurological problem. And our goal is to soon build a dedicated pregnant women's epilepsy program. And so, yes, we are very well-equipped and we have been doing this so UK Healthcare can provide optimal care for young women planning a pregnancy,
Caitlin Whyte: And that wraps up another episode of UK HealthCast with the University of Kentucky Healthcare. UK Healthcare offers the best and most advanced care for our epilepsy patients. Find out more on our website, ukhealthcare.uky.edu. Please remember to subscribe, rate and review this podcast and all the other University of Kentucky Healthcare podcasts. I'm Caitlin Whyte. Thanks for listening.