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Certain issues emerge when a child with epilepsy matures
into adulthood. Women and the elderly, in particular,
may have concerns about epilepsy and their overall well
being.
Driving, Sports, and Employment
Most people with epilepsy can control their seizures
by taking antiepileptic drugs, and thus, are able to
work and enjoy recreational activities much the same
as others unaffected by the condition. However, because
the possibility of breakthrough seizures exists, there
are some limitations that people with epilepsy must
adhere to for the safety of themselves and others.
- Driving. Most
states require a person to be seizure-free for a specific
amount of time before obtaining a regular drivers
license. New Jersey law calls for a one-year, seizure-free
period; applications to drive are reviewed by a special
unit within the Division of Motor Vehicles. Additionally,
New Jersey has a mandatory physician reporting requirement
under which doctors must inform the state when they
treat people over 16 years of age who have epilepsy.
- Sports. It is
permissible and even advisable for people with
epilepsy to exercise and participate in sports, with
proper precautions. Swimming, for example, should
be supervised and preferably done in a pool, rather
than the ocean, a river, or a lake. Overexertion and
dehydration can trigger seizures in some people, so
special attempts should be made to drink plenty of
water during exercise and not to overdo activity.
- Employment.
Many people with epilepsy can and do hold jobs. Also,
the Americans With Disabilities Act, a federal law,
prohibits discrimination against people with disabilities
in the workplace, as well as in many other situations.
People with epilepsy may be eligible for government-run
employment programs that provide job counseling, training,
and placement, as well as a transportation allowance.
The Female Factor
With each menstrual cycle, women of childbearing age
experience fluctuations in levels of the hormones estrogen
and progesterone. The primary function of these hormones
relates to the reproductive system, but both have been
found to affect certain brain cells. While estrogen
may contribute to seizures, progesterone may inhibit
them.
Some women with epilepsy have a greater number
of seizures at mid-menstrual cycle (when ovulation occurs)
and before their periods begin. These seizures, referred
to as "catamenial epilepsy," are linked to
hormonal changes, although the exact reason is not known.
One possibility is that not enough progesterone is being
produced during the latter part of the cycle. It may
be helpful for women to mark on a calendar when their
periods begin and when their seizures occur. A pattern
of catamenial epilepsy should be discussed with a doctor,
who may prescribe progesterone therapy to ease the menstrual-related
seizures. As noted earlier, progesterone is a hormone
that can have a inhibitive effect on seizures.
Sexuality
A person's sexuality doesn't disappear because he or
she has epilepsy. However, some people with epilepsy
have a low sex drive, while others have difficulty with
sexual response, i.e., impotence and painful intercourse.
Some of the sexual dysfunction reported by people with
epilepsy is psychosocial in nature, for example, low
self esteem or the fear of having a seizure during relations.
Physical reasons cannot be discounted, however. It's
possible that the abnormal discharge of electrical activity
within the brain affects desire and arousal. Significantly,
AEDs affect the same areas of the brain responsible
for sexuality, as well as cause changes in hormone metabolism.
While patients often hesitate to discuss sexual difficulties
with a physician, the encouraging news is that these
problems can sometimes be alleviated. For example, the
cause of painful intercourse may be vaginal dryness,
for which lubricating creams or gels can be recommended.
Medication can be prescribed to help men overcome impotence.
A doctor might prescribe a different AED to help alleviate
sexual difficulties, as a person may encounter sexual
problems while using one drug but not another.
Birth control is an important issue for couples who
want to avoid an unintended pregnancy. A gynecologist
can discuss the pros and cons of the various methods
of birth control, but women with epilepsy should know
that some antiepileptic drugs can reduce the effectiveness
of hormonally based contraceptives (such as the Pill,
implanted protection, and hormone injections). It is
often recommended that a second form of birth control
("barrier" protection such as a diaphragm or condom)
be used along with hormonal contraception.
Pregnancy
While the pregnancies of women with epilepsy are high
risk, the vast majority more than 90 percent result
in the birth of a healthy baby. It's important that
the pregnancy be planned so that prenatal care can begin
as early as possible-even before conception.
Prenatal vitamins, a significant part of any pregnancy,
are especially critical for women with epilepsy. Two
antiepileptic drugs (AEDs) in particular sodium valporate
and Tegretol are associated with an increased rate
of spina bifida, a neural tube defect, and a woman may
be taking one of these medications before she knows
she is pregnant. Folic acid, which is found in most
prenatal vitamins, reduces the risk of neural tube defects.
Another important factor for a healthy pregnancy is
the level of antiepileptic drugs the mother-to-be takes.
Ideally, she should be taking the lowest dosage of AED
possible that will completely control her seizures.
Taking multiple AEDs during pregnancy has been associated
with a greater incidence of birth defects. But no woman
with epilepsy should discontinue her medications without
the consent of her doctor.
About one-third of women with epilepsy experience an
increase in seizure activity during pregnancy. This
can be due to lack of sleep (also a trigger for seizures
in people who are not expecting); changes in how the
woman's body metabolizes the AED; failure to take AEDs
as directed; or a decline in blood levels.
Once a woman is in the last several weeks of pregnancy,
Vitamin K supplements often are recommended to reduce
the risk of a blood-clotting disorder in the baby that
results from fetal exposure to AEDs.
Because the pregnancy is considered high risk, pregnant
women with epilepsy will undergo more tests and screenings
than other women. Several ultrasounds of the developing
fetus may be ordered during the pregnancy, and possibly
an amniocentesis. Even with prenatal care, the potential
exists for difficulties with the pregnancy. Some studies
indicate that babies born to women with epilepsy have
a higher rate of developmental delays; whether this
is because of the effects of AEDs, the epilepsy itself,
or factors unrelated to epilepsy is not clear. If a
seizure causes a woman to fall, there may be injury
to the fetus; rarely during convulsions, the fetus can
be deprived of oxygen. Even seizures that do not cause
convulsions can produce uterine contractions that result
in stillbirth, bleeding, or miscarriage. However, it
bears repeating that most of the time, a woman with
epilepsy will give birth to a healthy child.
Menopause
During menopause, when menstrual cycles end, levels
of both estrogen and progesterone decrease. How lower
levels of these hormones affect seizure frequency varies
with the individual. Significantly, hormone replacement
therapy (HRT)is sometimes recommended for menopausal
women to reduce the risk of heart disease and osteoporosis.
However, HRT also is associated with an increased occurrence
of certain cancers. The risks and benefits of taking
supplemental estrogen and progesterone is a matter to
discuss with a physician for all menopausal women, but
especially for those with epilepsy, since estrogen tends
to increase seizure frequency, while progesterone can
reduce it.
The Golden Years
At the same time the rate of epilepsy is declining
in younger people, it is increasing among those over
age 60. Medical conditions that commonly occur in seniors
such as strokes and the hardening and narrowing of
blood vessels in the brain can make a person more
susceptible to epilepsy.
Epilepsy can be well controlled in seniors. However,
the side effects of antiepileptic drugs (AED) tend to
be more severe with people in this age group. Seniors
often take medication for other conditions, and there
may be an adverse interaction between the AED and the
other drugs. It is important that elderly patients tell
their doctors about all the medications they
take.
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