Pharmacological Management of Epilepsy in Women
Summary
The pharmacological management of epilepsy in women encompasses tailored selection and dosing of antiseizure medications (ASMs) to optimise seizure control while minimising adverse effects on reproductive health. Hormonal fluctuations across the menstrual cycle and life stages—from menarche through contraception, pregnancy and menopause—can alter seizure threshold and drug metabolism. Enzyme-inducing ASMs may compromise the efficacy of hormonal contraceptives and increase the risk of unintended pregnancy, while certain ASMs carry teratogenic risks and necessitate folic acid prophylaxis. Treatment strategies balance monotherapy against polytherapy to achieve remission with the lowest effective dose, recognising that dual regimens may increase teratogenic potential. Pre-pregnancy counselling, ongoing monitoring of ASM plasma levels and multidisciplinary coordination between neurology, obstetrics and pharmacy services are fundamental. Emerging research highlights novel pharmacokinetic models to predict dose adjustments during pregnancy and the development of ASMs with improved safety profiles for women of childbearing potential. Globally, integration of evidence into clinical guidelines aims to harmonise standards of care, reduce adverse maternal and foetal outcomes, and empower women through shared decision-making.
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Pharmacological Management of Epilepsy in Women publication trend
The graph below shows the total number of articles in pharmacological management of epilepsy in women across all publications each year (not limited to Nature Index journals).
Technical terms
Antiseizure medication (ASM): A pharmaceutical agent used to prevent or reduce the frequency of epileptic seizures.
Monotherapy: Treatment of epilepsy with a single ASM, aiming to achieve seizure control while limiting side effects.
Polytherapy: Use of two or more ASMs concurrently, often reserved for refractory epilepsy but associated with increased adverse-effect risk.
Teratogenicity: The capacity of an ASM to cause developmental malformations in the foetus when administered during pregnancy.
Enzyme induction: A pharmacokinetic process by which certain ASMs accelerate metabolism of co-administered drugs, including hormonal contraceptives.
Folic acid prophylaxis: Administration of folate supplements to reduce the risk of neural tube defects in the foetus when ASMs are taken pre-conception and during pregnancy.
References
- What do women with epilepsy know about pregnancy?. South African Family Practice (2024).
- Терапия эпилепсии у женщин – дополнительный саногенетический эффект, обусловленный приемом топирамата. Неврология, нейропсихиатрия, психосоматика (2015).
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