**7. Conclusion**

In conclusion, in gynecological practice, women with epilepsy deserve special care with a multidisciplinary approach. Women with epilepsy should be questioned routinely about menstrual cycles, infertility, excessive weight gain, hirsutism, galactorrhea, and changes in sexual life. If abnormalities are detected, hormone determinations, pelvic ultrasound, and neuroimaging of pituitary gland should be assessed. If the cause of the problem is AED-

The Impact of Epilepsy on Reproductive Functions 65

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Christensen J, Petrenaite V, Atterman J, Sidenius P, Ohman I, Tomson T, et al. Oral

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Galimberti CA, Mazzucchelli I, Arbasino C, Canevini MP, Fattore C, Perucca E. Increased

steroids in women with epilepsy. Epilepsia September 2006;47 (9):1569—72. Genant HK, Cann CE, Ettinger B & Gilbert SG. Quantitative computed tomography of

Gerendai I, Halasz B. Neuroendocrine asymmetry. Front Neuroendocrinol 1997;18:354–81. Gold EB, Bromberger J, Crawford S, et al. Factors associated with age at natural menopause in a multiethnic sample of midlife women. Am J Epidemiol 2001;153: 865–74. Harden CL, Herzog AG, Nikolov BG, et al. Hormone replacement therapy in women with

Harden CL, Koppel BS, Herzog AG, et al. Seizure frequency is associated with age at

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interactions, contraceptive options, and management. Int Rev Neurobiol.

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related, a therapeutic alternative should be addressed, taking into account seizure control possibilities versus side effects.

Seizures generally exacerbate during the 3 different periods of the menstrual cycle: in perimenstrual and periovulatory periods in normal cycles, and in inadequate luteal phase in abnormal cycles. This type of epilepsy is defined as catamenial epilepsy and is under the influence of estrogen and progesterone. Estrogen has been shown to increase seizure activity, while progesterone decreases it by raising the seizure threshold level.

The prevalence of PCOS in women with epilepsy is 10-20%, which is greater than the normal population, even if epileptic women are not taking AEDs. PCOS is more frequent in women who take VPA, primarily if initiated before the age of 20.

Women with epilepsy have an increased risk of experiencing an early onset of perimenopausal symptoms. Some studies draw attention to the increased frequency of POF in women with epilepsy, although this relationship needs to be further investigated.

In women with epilepsy, failure of oral contraceptives may increase to 6% depending on the antiepileptic drug they are taking. Barbiturates, Carbamazepine, Oxcarbazepine, Phenytoin, Primidone, and Topiramate (>200 mg/day) may reduce the efficacy of oral contraceptives. Clonazepam, Ethosuximide, Felbamate, Gabapentin, Levetiracetam, Lamotrigine, Tiagabine, and VPA do not seem to interact with oral contraceptives. During the first months of oral contraceptive use, and once ovulation has been eliminated, complementary contraceptive methods are recommended. Non-hormonal contraceptive methods are not contraindicated in women with epilepsy. There is no evidence that combined-oral contraceptives increase seizures in women with epilepsy.

During menopause, 27% of the epileptic women had improvement, 33% did not modify their seizure pattern, and 40% worsened. Monitoring for osteoporosis is recommended, particularly if treatment is with AEDs which reduce steroid hormone levels. According to the The European Menopause and Andropause Society (EMAS) position statement, epileptic women starting hormone therapy should be closely monitored as their AED needs may change; calcium and vitamin D supplements should be considered, and herbal preparations should be avoided as their efficacy is uncertain and they may interact with AEDs (Erel et al, 2010).

#### **8. References**


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The prevalence of PCOS in women with epilepsy is 10-20%, which is greater than the normal population, even if epileptic women are not taking AEDs. PCOS is more frequent in

Women with epilepsy have an increased risk of experiencing an early onset of perimenopausal symptoms. Some studies draw attention to the increased frequency of POF

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**5** 

**The Classification of Seizures and** 

Understanding the classification of epileptic seizures is the first step towards the correct diagnosis, treatment and prognostication of the condition. The initial management of a patient with seizures begins with an understanding of the patient's seizure type and, if pertinent, epilepsy syndrome. Specific seizure types or syndromes often respond better to specific medications or surgical approaches. Some seizure types or syndromes carry a benign prognosis or high likelihood of seizure remission by a certain age. Other seizure syndromes may carry a far poorer prognosis, and early knowledge of this allows focused

The classification of epileptic seizures is still largely based on clinical observation and expert opinions. The International League Against Epilepsy (ILAE) first published a classification system in 1960. The last official update for seizures was published in 1981, and the last official update for the epilepsies was in 1989. By definition, epilepsy is diagnosed after a patient has two or more unprovoked seizures. The 1981 and 1989 updates form the officially accepted classification system, although there continues to be efforts to develop a clinically meaningful revision to the current system. A report in 2010 by the ILAE Commission on Classification and Terminology recommended that changes be made in the current conceptualization, terminology, and definitions of seizures and epilepsy. This chapter will focus primarily on the currently accepted standard based on the 1981 and 1989 reports, and

Partial or focal seizures comprise one of the two main classes of epileptic seizures, with generalized seizures being the other. Partial seizures are subdivided between simple and complex partial seizures, which are distinguished by the presence or absence of impairment of consciousness. Simple partial seizures are defined as seizures without impairment of consciousness while complex partial seizures are defined as seizures with impairment of consciousness. Consciousness is defined as the "degree of awareness and/or responsiveness of the patient to externally applied stimuli". Responsiveness refers to the ability of the patient to respond to external stimuli, and awareness refers to the recall of events occurring

treatment and lifestyle modifications for patients and families.

discuss the recommendations of the 2010 ILAE report.

**2. The classification of epileptic seizures** 

**1. Introduction** 

**2.1 Partial seizures** 

**Epilepsy Syndromes** 

*1Emory University School of Medicine,* 

*2Mayo Clinic Florida* 

*U.S.A.* 

Leslie A. Rudzinski1 and Jerry J. Shih2

