For your convenience we offer two versions of the Physician's Discussion Checklist for Women with Epilepsy in PDF Format, ready to print. Depending on your needs in working with your patients, you may print either the one page version or 2 page version.

To the Physician:

Use this background material and checklist as a guide for discussions of important issues with teens & women of all ages who have epilepsy. This is not a script, but a reminder of major topics as well as documentation of your discussion with the patient. Please use the accompanying Discussion Guide for specific information.

The checklist is divided into sections appropriate to different life stages.

Patients with new-onset epilepsy, and those new to your practice, require detailed information; continuing patients may need follow-up discussions as they mature & their situations change. The status of teens & women who are not currently sexually active could change between visits. They may need up-to-date information & options appropriate to their current lifestyle. Women approaching menopause have their own specific concerns.

Check all areas covered in this visit, date and sign this form, & have your patient sign it as well. File the form in the patient's chart for reference at subsequent visits. Download background information for your use & patient handout materials from Professionals. Make notes of specific strategies discussed for follow-up discussions and refer patients to Epilepsy.com for information.

This Discussion Checklist was developed by the Epilepsy Foundation to help physicians treating women with epilepsy. The issues were reviewed by a panel of epilepsy experts:

FOR ALL WOMEN, ADOLESCENTS, & PRE-TEENS DURING REPRODUCTIVE YEARS

  • Relationship between hormones & epilepsy (overview)
  • Possible menstrual cycle-related influence on seizure susceptibility (catamenial epilepsy)
  • Impact of epilepsy on sexual & on reproductive issues
  • Although women with epilepsy have a slight decrease in fertility overall, epilepsy by itself is seldom a cause of infertility. Consult infertility specialist if there is difficulty conceiving 
  • Relation of some AEDs to libido and potency problems
  • Women with epilepsy CAN become pregnant with or without AEDs; importance of careful pregnancy planning including folate supplementation
  • Need for effective & consistent contraception to avoid unplanned pregnancy
  • Effective contraception choices (interactions between hormonal contraception & certain AEDs; possible contraceptive failure and need to consider barrier method for added protection)
  • Other forms of contraception (patch, IUD, Depo Provera®)
  • Need to inform neurologist if contraception is discontinued
  • Need for calcium supplementation and vitamin D for bone health

Note: Confirm the diagnosis of epilepsy & seizure type. In all discussions, emphasize the balance of all risks & the goal of controlling seizuresWOMEN PLANNING TO CONCEIVE OR MIGHT BECOME PREGNNT IN FUTURE

  • Healthy pregnancies & healthy babies are the goal
  • Need for optimum seizure control
  • All risks to maternal and child outcomes (women not taking AEDs also have risks)
  • Risks to the baby from AEDs must be balanced with risk of seizures to baby & mother
  • Ways to reduce risks to mother & baby (eg,AED choices; folate supplementation)
  • Appropriate AED medication/need to optimize before pregnancy; importance of NOT making any changes without neurology consultation (maintaining good compliance)
  • Identify an obstetrician comfortable treating a woman with epilepsy
  • Need for folate supplementation (if patient is taking any enzyme-inducing drug, folate dose will need to be higher)
  • How pregnancy can affect seizure frequency & severity
  • Fertility treatments & possible effects on AED levels & seizure susceptibility

PREGNANT WOMEN

Note: Confirm the diagnosis of epilepsy & seizure type. In all discussions, emphasize the balance of all risks & the goal of controlling seizures

  • Consultation with patient’s obstetrician
  • Possible teratogenic effects compared to people not taking an AED
  • Possible changes in AED therapy (only in consultation with neurologist)
  • Close monitoring of AED dose & blood level
    • For patients requiring multiple AEDs for seizure control, discuss choices and risks
  • Vitamin K recommendations for mother before delivery & for baby at time of birth
  • Need to bring AEDs to the hospital during labor and to take regular doses
  • AED dose adjustment following delivery and post-partum follow-up
  • Breastfeeding/safety for the newborn
  • Newborn appointment for neurologist evaluation (age 4-6 wks)
  • Parenting issues to maximize safety for the newborn including minimizing mother’s fatigue to avoid seizure exacerbation & home safety preparations
  • Have ultrasound first and second trimester

WOMEN BEYOND CHILDBEARING YEARS

  • Bone health & need for calcium supplementation & bone density monitoring; seizure control to prevent falls
  • Peri-menopause effects on seizures/AEDs
  • Menopause/hormone replacement issues; enzyme-inducing effects of hormones on AEDs
Reviewed by: Kimford J. Meador MD on 3/2014
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