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The main areas to consider are:
- AEDs and appearance
- Female hormones and seizure control
- Fertility
- Contraception
- Pregnancy
Phenytoin therapy in childhood can cause hirsutism, gingival hyperplasia and coarsen of facial features. Sodium valproate can cause hair loss, acne and hirsutism. Sodium valproate can also stimulate appetite leading to obesity, as can vigabatrin, gabapentin and pregabalin.
Conversely, topiramate can cause significant weight loss
Experimental evidence from animal studies suggests that the change in seizure frequency during the menstrual cycle may be related to the relative oestrogen and progesterone concentrations, with oestrogens being considered to have pro-convulsant and progestogens anticonvulsant properties, respectively.
A reasonable treatment option in women who develop PCOS and/or ovulatory dysfunction while taking valproate is to consider discontinuation of the drug and treatment with an alternative AED, if possible.
The AEDs phenobarbital, primidone, phenytoin, carbamazepine, topiramate and eslicarbazepine acetate are inducers of the hepatic P450 microsomal isoenzyme CYP3A4 which is responsible for the metabolism of oestrogens and progestogens. This results in increased metabolism of the combined oral contraceptive pill and can lead to failure of OCP.
Obstetric/neurology pre-conceptual counselling service should be available to allow rapid assessment of women actively contemplating pregnancy and to coordinate care during pregnancy. The risk of major congenital malformations is at least doubled (4-9%) in women receiving AEDs, compared with the general population (2-3%) must be discussed.
The prescription of folic acid before conception and at least until the end of the first trimester is recommended in patients taking antiepileptic medication, as it is for all women. It causes an increased risk of neural tube defect in children born to mothers taking AEDs, in particular, sodium valproate and carbamazepine.
Manipal Hospital Dwarka is the best hospital for neurology treatment in Delhi having the best doctor for epilepsy in Delhi who work together to provide the highest level of patient care. Women with epilepsy should immediately consult the best neurologist in Delhi for the best treatment procedures.
Consultant, Neurology
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