WOMEN AND AEDS
There are particular considerations that need to be taken into account when supporting women with learning disabilities who have epilepsy. Women with learning disabilities should not be excluded from the same services available to all women, but information may need to be modified in order to meet their needs. The issue of contraception needs to be considered carefully with women of child-bearing age.
Non-hormonal contraception methods have no side effects for women with epilepsy. It needs to be noted that hormonal contraception methods, such as the contraceptive pill, may affect the usefulness of the AEDs. This is primarily because of the interaction of female hormones with AEDs. AEDs such as sodium valproate and newer AEDs lamotrigine and levetiracetam do not impact on the effectiveness of hormonal contraceptives. However, carbamazepine, phenobarbitone, phenytoin, primidone and ethosuximide do reduce the effectiveness of hormonal contraceptives. These issues need to be discussed with both the epileptologist and the woman’s GP (Royal Society of Medicine 2004).
Women with mild learning disabilities and epilepsy need to be offered advice about pregnancy, preferably before becoming pregnant, in the same way as other women with epilepsy. These issues should be discussed at every annual review of epilepsy (or when the woman’s condition dictates) while the woman is of child-bearing age. Where pregnancy occurs, the woman will still need to continue taking AEDs, although adjustments to the dosage may be made by the epileptologist. The danger to the mother and baby from not taking AEDs and having seizures is usually greater than that associated with taking AEDs (British Medical Association and the Royal Pharmaceutical Society 2005; NICE Guidelines 2004).
Further detailed guidance on the management of pregnancy, labor and caring for the baby can be found in Primary Care Guidelines for the Management of Females with Epilepsy (October 2004), and from the National Society for Epilepsy website. Additional guidance has been issued by Stokes et al. (2004).
