A significant number of nearly 1.5 million women of childbearing age in India deal with epilepsy (1). This underscores an urgent requirement for tailored care and assistance. Epilepsy impacts approximately 50 million people worldwide, with a substantial portion residing in India, where an estimated 10-12 million individuals are affected. However, social stigma and reluctance to seek medical help often obstruct women from accessing the necessary care. Concerns related to reproductive health pose a significant challenge among women with epilepsy. Nevertheless, experts emphasized that appropriate treatment can enable women to lead normal and healthy lives.

Why Indians Fail to Seek Treatment for Epilepsy?

Dr. Siby Gopinath, an Epileptologist and Professor of Neurology at Amrita Hospital, Kochi, highlighted the concerning treatment gap in managing epilepsy, particularly in low-resource settings like rural India. With nearly 1.5 million affected women in India, special attention must be given to those of reproductive age, given the unique challenges pregnancy poses. Issues such as the teratogenic effects of antiepileptic drugs (AEDs) and increased infertility rates are significant concerns (2).

Neuroinfections, head trauma, and metabolic abnormalities significantly contribute to the burden of epilepsy in India, especially among women of reproductive age. Children are also significantly impacted, with the highest incidence occurring in the first year of life and peaking between ages 1 to 12. Diagnosing epilepsy in children is challenging due to various seizure imitators, necessitating evaluation by trained paediatric neurologists.

Can Women With Epilepsy Plan a Pregnancy?

Experts emphasized that women with epilepsy can plan pregnancies if they have been seizure-free for two years or more. Collaboration between neurologists, gynaecologists, and paediatricians is crucial to managing medications during pregnancy and addressing any seizures promptly.

Dr. AK Sahani, Director and Chief of Neurology at the Indian Spinal Injuries Centre (ISIC) in New Delhi, stressed the importance of addressing the unique challenges faced by women with epilepsy, including social stigma, to ensure they receive the necessary medical attention. He emphasized the significance of planning pregnancy to avoid harm from anti-epileptic medications to both the baby and the mother.

Treatment for Women With Epilsepy

Regarding treatment options, Dr. Amlan Mandal, Senior Consultant in Neurology at Narayana Hospital RN Tagore Hospital, outlined a comprehensive approach involving medical history, physical examination, and various investigations. Treatment may include anti-seizure medications, though finding the right medicine and dosage may take time. Surgery may also be considered, especially in cases of drug-resistant epilepsy, such as removing brain tumours, or utilizing Deep Brain Stimulation (DBS) when the origin of seizures is unclear.

While epilepsy presents challenges, early diagnosis, appropriate treatment, and collaborative care can significantly improve the quality of life for affected individuals, particularly women of reproductive age.

References:

1. Epilepsy in Pregnancy-Management Principles and Focus on Valproate
   
   Błaszczyk B, Miziak B, Pluta R, Czuczwar SJ. Epilepsy in Pregnancy-Management Principles and Focus on Valproate. Int J Mol Sci. 2022 Jan 25;23(3):1369. doi: 10.3390/ijms23031369. PMID: 35163292; PMCID: PMC8836209.




2. Reproductive health effects and teratogenicity of antiepileptic drugs
   
   Kaplan PW. Reproductive health effects and teratogenicity of antiepileptic drugs. Neurology. 2004 Nov 23;63(10 Suppl 4):S13-23. doi: 10.1212/wnl.63.10_suppl_4.s13. PMID: 15557546.




3. Management of epilepsy in women
   
   Stephen LJ, Harden C, Tomson T, Brodie MJ. Management of epilepsy in women. Lancet Neurol. 2019 May;18(5):481-491. doi: 10.1016/S1474-4422(18)30495-2. Epub 2019 Mar 8. PMID: 30857949.

Source-Medindia