Epilepsy & Adults

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Epilepsy

Epilepsy in women raises separate issues.

Menopause

When women go through the menopause, it is quite common for them to take hormone replacement therapy (HRT). HRT contains oestrogen which is known to be a seizure trigger. However, in general the oestrogen levels in HRT are not high so therefore should not adversely affect seizure control. If seizure frequency and severity increase during HRT it might be worth discussing with a neurologist.

Breast feeding whilst on anti-epileptic medications is advocated on the basis that it is thought that the benefits to the baby outweigh the risks associated with the transmission of small amounts of the drug. Some drugs may make the baby overly sleepy, for example Phenobarbitone, and it is worth discussing this with a neurologist prior to commencing breast-feeding.

Pregnancy

Some anti-epileptic medicines can have an adverse effect on the baby whilst in the womb. These effects include physical abnormalities, cognitive abnormalities, learning disabilities and behavioural problems. Taking 5 mg per day of folic acid can help reduce the chances of these effects occurring. Some drugs have had extensive research done into them and some drugs have more effects associated with them than others. If you are planning to become pregnant, it is a good idea to see a neurologist for pre-conceptual counselling. It may be necessary to alter your medications, alternatively if you have been seizure free for two or three years, slowly stopping medication may be an option.

Most women with epilepsy experience no increase in frequency of seizures during their pregnancy. If they do, it is often due to problems concerning the anti epileptic drug. Sometimes it might be that morning sickness is causing the drug not to be properly absorbed or the blood levels may become low. Women use up more of the anti epileptic drug during pregnancy which could cause more seizures.

Epileptic seizures do not often harm the baby in the womb. The biggest risk is if the mother falls and is injured during a tonic clonic seizure for example but in general the baby is well protected in the womb.

Women with epilepsy tend to have completely normal deliveries. The chances of a tonic clonic seizure occurring during labour are minimal but it is advisable that because of this small risk, women with epilepsy consider the possible consequences of a home or water birth. If you have a tonic clonic seizure during labour, drugs can be given to deal with it.

Women with epilepsy can have the same types of pain relief during labour as those without with the exception of pethedine which is thought to be a seizure trigger.

Certain types of anti-epileptic drug can interfere with the effectiveness of some forms of the contraceptive pill. These drugs are enzyme producing inducing drugs and they break down hormones including those in the contraceptive pill. Below is a list of these drugs:

It is advisable that if you are on these drugs you take a pill with a higher amount of oestrogen. It might still be advisable to use additional forms of contraception.

Infertility rates amongst women with epilepsy tend to be much higher than those without. Social and psychological factors play a part in this. Some women feel afraid to have children in case they pass their epilepsy down to them. Additionally it has been found that a significant number of women with epilepsy have abnormal menstrual cycles and some do not ovulate at all. Poly cystic ovaries (PCOS) are relatively common in women with epilepsy and are often associated with sodium valproate. PCOS can be a cause of infertility. Symptoms include obesity, irregular menstruation and hirsutism. However, these factors do not mean that it is impossible for women with epilepsy to reproduce as fertility treatment is often available and successful. It is also possible to change the effects by altering your anti epileptic medication.

Fertility

Hormonal changes during the menstrual cycle can affect seizure frequency. Oestrogen is known to provoke seizures, whilst progesterone inhibits them. During menstruation there is a surge in oestrogen due to ovulation thus seizures can become more severe. Some women only encounter seizures during their period and this is known as catamenial epilepsy. It is possible to take an extra anti epileptic drug during the week of your period but this should be done with guidance from a consultant.

Menstrual cycle

Epilepsy and Driving

This section explains driving law in the United Kingdom in relation to seizures. Other nation’s driving regulations may vary.

Because of the nature of seizures, it is required by law that anyone who has experienced a seizure of any type stops driving. Licences can be reapplied for after you have been seizure free for a period of twelve months with or without medication. You are responsible for informing the DVLA if you have a seizure. If you fail to do so your licence will be legally invalid, as will your insurance meaning that you will be driving illegally.

Provisional Licence

In order to apply for a provisional licence to learn to drive, you must have been seizure free for twelve months. The DVLA needs to be informed on your initial application form of your medical condition. They will then send you additional forms asking for details on your epilepsy and may contact your doctor for further information.

Nocturnal Seizures

If you have a nocturnal seizure (a seizure whilst sleeping) you are also legally required to surrender your driving licence for one year. However, if you continue to solely have nocturnal seizures for three years you can apply for a new licence. You can continue to drive whilst only having nocturnal seizures.

Provoked Seizures

If your seizure is considered to be provoked such as an immediate effect of a head injury, this may be considered by the DVLA to be an exceptional circumstance. If this cause is rectified, the DVLA may consider allowing you to drive. Such cases are viewed individually by the DVLA and factors such as alcohol and drugs are not considered to be exceptional circumstances.

Medication Changes

Because of the risk of changes to seizure activity as a result of changing or stopping medications, the DVLA recommends that you stop driving for six months following such changes.

Group 2 Vehicles

Vehicles that are covered by a Group 2 licence (LGV or PCV) have different regulations than Group 1 vehicles. To obtain a Group 2 licence you need to have been seizure free for 10 years without the assistance of anti-epileptic medication and be able to satisfy the DVLA that you are unlikely to have any further seizures.

Insurance

Your motor insurance premium should not be increased because of your epilepsy. This is covered in the Disability Discrimination Act.

Travel Costs

If you are unable to drive due to your epilepsy, you may be able to receive help with travel expenses in the form of reduced fares for buses, coaches and trains. Further information on rail cards can be found at www.disabledpersons-railcard.co.uk

Bus discounts normally vary regionally; contact your local bus station for further information.