Managing Epilepsy with Women in Mind PDF

Preface

Women with epilepsy need a more female-orientated service since they have different needs from men with epilepsy at various stages in their life. Yet services for people with epilepsy in the UK remain androcentric and largely ignore the fact that 50% of the recipients of epilepsy care in the UK arc female. In deed, 40% of those who engage with epilepsy services are women of childbearing potentiai. (There is currently a mass legal action for compensation taking place in the UK instigated by the mothers of children allegedly damaged by exposure to anticonvulsant medication in the womb, and epilepsy is now the second commonest cause of maternal death.)

Epilepsy is probably slightly more common in men than women (but then women tend to have fewer head injuries). However, some forms of epilepsy are exclusive to, or much commoner in, women. This may be because similar cpilcpsics in males lead to prenatal death. Although women may be more advantaged than men (for instance, they live longer) they have biological tides that men do not and which may make them more likely to have seizures at certain times in their menstrual cycle and also in, or just after, pregnancy and during the climateric. There is no doubt that epilepsy and its treatment can affect or compromise the menstrual cycle, contraception, fertility, pregnancy, development of the fetus in the womb and the child afterwards, child care and the menopause. Conversely, the menstrual cycle1 contraception, pregnancy and the menopause can affect epilepsy and its management.

This book is based on experiences over the past 10 years of one of the very few clinics for women with epiLepsy in the UK and on the curriculum of the Birmingham University Master's Course in Epilepsy. It attempts ro address these issues using evidence-based recommendations for care where possible, but in many areas where evidence is lacking and further research is needed management recommendations are based on audited clinical experience.

This book has been written with three groups of readers in mind: general practitioners1 who need this information if they are to review the care of their female patients with epilepsy (now a primary care requirement), midwives, gynaccologists and obstetricians (who also need an introduction to the modern management of epilepsy itself if they are to understand the needs of their patients), and specialist nurses in epilepsy who are becoming increasingly important in delivering care to women with epilepsy.

In addition to reviewing the evidence that underpins the management of women with epilepsy, there is also a quick reference guide to anticonvulsant drugs, their usage, doses, side effects and contraindications (relative and absolute), particularly in terms of their use in women, as many readers will be unfamiliar with them. Thus, this short up-to-- date text about epilepsy is written from the point of view of women with the condition. The management of men is also considered but given second place to women. This is the right way round for reasons that should become obvious as the book is used.

The book has been adapted and developed from a small book Women and Epilepsy written by the present author and Pamela Crawford, a neurologist, nearly 10 years ago. Some of the speculation in that book has hardened into fact. It is more generally accepted that, in their epilepsy needs, women are different from men but much is still guesswork and women's needs still undervalued as far as epilepsy is concerned. Hopefully, this present book will help to put that right. For that reason, too, in this book ‘she' embraces ‘he and will he used as the pronoun, unless to do so would part company with sense