Ask the Expert: Epilepsy and the 18 to 24 Year Old Woman

Introduction

Women with epilepsy face challenges during their young adult years that are unique to this specific time in their lives. They may be making decisions and considering different lifestyle options that could have a profound effect on their future.

Certain issues such as dating and contraception raise questions like, "Should I tell the guy I'm dating that I have epilepsy?" "How can I explain to him what my seizures look like?" "Should I talk to my neurologist or my gynecologist about birth control and whether oral contraceptives will interact with my seizure medication?" Young women with epilepsy need to exercise sound judgment regarding disclosure of their condition in an intimate relationship and the issues to consider as they experience their sexuality.

Watching your diet is an important factor for seizure control. Sometimes it can be difficult to maintain a balanced, nutritious diet when you are juggling classes and study time or that first job out of college. It is also important to make sure you are getting an adequate amount of sleep. If you are a student, early morning classes and late-night study sessions may deprive you of sleep, which may increase your seizure risk. Logging late nights at the office may compromise your ability to get to bed at a reasonable hour.

The post-adolescent years are a time when people, both men and women, more fully develop their professional and social lives. Young women with epilepsy may find it difficult to deal with unpredictable seizures and possible side effects of medications. The random nature of seizures that may prevent driving, as well as medicines that may alter moods or energy level may present challenges when establishing personal and professional relationships. However, being educated about the condition and maintaining an open relationship with a treating physician will empower most young women with epilepsy to live life fully despite seizures.

My daughter is 22. She is back on Depakote after having been off of it for about 6 years. Will Depakote affect her already painful periods for the worse? Will she suffer again from the weight gain and hair loss that she did as a child on Depakote?

Depakote can change the hormone levels in female patients. There is no data on how Depakote affects menstrual cramps. If she is already having painful cramping it is possible that may continue. Depakote is associated with weight gain and hair loss. It is possible that those side effects experienced in the past may reoccur. However, how a drug is metabolized does change with age and may affect the side effects a person may experience. (Editor's Note: All epilepsy drugs have side effects. For example, several drugs cause weight gain and/or hair loss. Some cause weight loss. Please review potential drug side effects with your health care team.) 

How can I control my emotions and educate others about my epilepsy without getting defensive and shutting down the conversation?

It is human nature to be curious and have misconceptions about things we don't understand. Your positive attitude is the best approach to any chronic condition. You need to be able to answer questions people may have in an educated manner without letting your emotions show. Refer them to reputable sources for a greater understanding (i.e. this website).

I'm starting to have a lot more seizures than I did when I was in high school. I try to get enough sleep, but I have a lot of course work and usually have to stay up late to finish it. I've tried taking short naps during the day, but it doesn't seem to help much. I've been having a couple of seizures a week. Do you have any suggestions?

It is well known that sleep deprivation can exacerbate seizure activity. This is especially difficult for students and young adults who often have late nights. The obvious answer is to try to get a minimum of eight hours of uninterrupted sleep each night, and complete course work during the day. Budget your time efficiently during this busy time of year. Try to avoid caffeine and alcohol as well. You may want to consult with your physician about increasing medication during this time or temporarily using a second medication.

I'm worried that my birth control pills aren't as effective as they should be because I also take Lamictal. Should I see if my gynecologist can prescribe me a stronger birth control pill? Would the birth control patch work better?

Some antiepileptic medications increase the metabolism of the estrogen in oral contraceptives and can make them less effective by 6 percent. A higher dosed estrogen pill is recommended (estrogen 50 cgs or higher) if you take medication that increases the clearance of oral contraceptives. Current studies indicate that like many other antiepilepsy drugs, Lamictal affects the effectiveness of oral contraceptives.

Can you tell me if smoking will cause me to have more seizures? I know it's bad for my health to smoke and most doctors would say quit regardless, but will smoking cigarettes cause an increase in my seizure activity?

There is no known link between smoking and seizure frequency. My concern is always safety if you have a seizure while you are smoking.

Do any antiepileptic medications cause a decreased desire for sex? How about painful intercourse?

Some of the older antiepileptic drugs like Phenobarbital, carbamezepine and phenytoin interact with hormones that may cause a lower sexual desire. These medications are not associated with complaints of painful intercourse. There are many causes for painful intercourse that should be evaluated by your gynecologist.

I know that I am not supposed to use alcohol while taking antiepileptic medication, but will it really hurt me if I have one or two drinks occasionally?

The use of alcohol is associated with lowering the seizure threshold. Limiting to one drink while at a social occasion is acceptable as long as you are aware of the potential lowering of the seizure threshold. Alcohol can also change your medication levels.

I'm finishing my last year of college and am preparing to look for a job. How can I explain my seizure disorder to potential employers? Do I have to mention it during an interview?

You do not have to disclose your epilepsy to potential employers. You are protected against job discrimination under the Americans with Disabilities Act. You can refer to the Epilepsy Foundation for more information on job interviews.

I've just told my boyfriend that I have epilepsy. Now he's worried that I might have a seizure during sex. I've told him that my seizures are pretty well controlled — I only have one or two a year — but he's still worried. Are seizures more likely to occur during intercourse?

There is no evidence that seizures are more likely to occur during intimacy. When a seizure will occur is often times unpredictable. Your epilepsy sounds well controlled. You may want to educate your boyfriend about epilepsy so he will feel more comfortable in your relationship.

I've recently been diagnosed with epilepsy. Can I still participate in sports? I am attending college with the help of an athletic scholarship and would not be able to afford to continue my education without it.

It does depend on what sport you are participating in. Having epilepsy does not exclude you from playing sports as a rule. High impact sports and swimming alone are not recommended. Certain training techniques cannot be done unsupervised like lifting free weights. You may want to also consider that excessive physical activity and hyperventilation may exacerbate seizures.

This event was posted in October 2004.