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Epilepsy in women: a practical guide to management
  1. Margaret Jackson
  1. Consultant Neurologist, Regional Neurosciences Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK; margaret.jackson@ncl.ac.uk

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    Why devote a whole review to the management of women with epilepsy? After all, in many respects epilepsy in women is little different from epilepsy in men; the investigation, diagnosis, and many aspects of treatment are identical. But women are different. The menstrual cycle, contraception, pregnancy, and the menopause can all influence epilepsy, and its treatment. Women’s lives have different phases: education, career development, child rearing with or without work, then a return to work or continuation of a carer’s role within the extended family. Many women now raise children in single parent households as well as working outside the home. Management of epilepsy in women demands not just knowledge of epilepsy but also recognition of the various roles and priorities women have in their lives, and the ability to help them manage their condition successfully through changes in their circumstances.

    This article is intended to provide a summary of current evidence, such as it is, on the aspects of epilepsy specific to women. There are no large, double blind, randomised trials and meta-analyses and therefore much opinion is based on small studies with little power and a high risk of bias. Pharmaceutical companies have been quick to exploit data which appear to disadvantage products that compete with their own, and it is sometimes difficult to separate “spin” from fact. Valproate in particular has received unfavourable comparison with lamotrigine. But recent data on the teratogenicity of lamotrigine, disclosure of interactions between lamotrigine and the oral contraceptive, and the abiding clinical impression that valproate is more effective in the idiopathic generalised epilepsies1 begs the question as to whether valproate has been unfairly damned.

    THE MENSTRUAL CYCLE AND EPILEPSY

    The onset of puberty and menstruation may coincide with the development of epilepsy in young women. Both juvenile absence epilepsy and juvenile myoclonic epilepsy can present in …

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