Questions & Answers with Jacqueline A. French, M.D.

Posted: July 29, 2004

Question: Can a change in medication change your menstrual cycle?

Answer: Yes, some medications can cause changes in menstrual cycling. Seizures in epilepsy can also cause changes. Recent studies have suggested that women with epilepsy may have more anovulatory cycles (a menstrual cycle where a normal period may happen, but there is no ovulation) than other women.

Question: Can medications be stored in the body during periods of low appetite, then released when eating returns to normal?

Answer: There isn't much effect of food intake on medication. Sometimes, the medication will get into the body faster with food, or in some cases when fasting. However, eventually the total amount of medication released should be the same whether you've eaten or not. This means that you may feel some greater early effect of the medicine either taking it with food, or taking it in a fasting state, depending on the medication that we were talking about. However, the medication will not build up in the body.

Sometimes your overall need for medication may change depending on your body weight. If you have had a significant change in body weight, you should ask your doctor about whether the dosage should be changed.

Question: Recently, I learned women with epilepsy have a higher likelihood of getting bone diseases. Please explain why and what we can do to lessen our risk.

Answer: Epilepsy itself does not cause a problem with bones. However, there is increasing evidence that some epilepsy meds will cause a disturbance. The best evidence exists for the drug phenytoin (Dilantin). This drug may interfere with vitamin D. Vitamin D is important for calcium in bones. Recent research has indicated that people who have been on Dilantin for a long period of time may have an increased risk of decreased bone density. This can be evaluated with a test known as a dexascan. It is now recommended that a dexascan be performed every one to two years for people on Dilantin.

Other medications may also affect bone health, but there is less firm information. It is recommended that individuals who are taking seizure medication should receive dietary supplements of vitamin D with calcium. This will reduce the impact of the medication on the bones. Talk to your doctor about the whether there is impact on bone health from the medication you are taking.

Question: I've read that menopause can either increase or eliminate seizures. Any way of predicting which way I'll go?

Answer: Your reading is exactly correct. Menopause affects different women in different ways. This is also true of pregnancy. In both pregnancy and menopause, some women's seizures will worsen, whereas others will improve. There really is no way at the present time to predict which way any one individual will go.

Question: Do hormones or hormonal cycles have anything to do with seizures?

Answer: There is very good evidence that some women have increased susceptibility to seizures either immediately before or during menses. This is probably because estrogen is somewhat epileptogenic, whereas progesterone may protect against seizures. During the cycle, there are changes in the balance of estrogen and progesterone.

At this very moment, clinical trials are underway to determine whether treatment with progesterone may help women whose seizures are associated with the menstrual cycle. Hopefully, in the next several years, we will have good Answer:s as to the best way to address this problem.

Question: Is there a connection between mood swings and seizures?

Answer: There may be several connections between mood swings and seizures. Firstly, medication may be a factor. Some medications are associated with an increase in mood swings. You can ask your doctor whether the medication that you were on is one of them.

Also, people with epilepsy have an increased risk of depression. If depression is an issue, antidepressants work very well. Another factor may be the seizures themselves. Sometimes, people will have a change in mood around the time of the seizure or seizure cluster. In these cases, the best seizure control will produce the best likelihood of mood stability.

Several women joined Jacqueline French this spring as part of the Ask the Experts online series. French is a professor in the department of Neurology at the University of Pennsylvania . She is co-director of the Penn Epilepsy Center and director of clinical drug trials. French trained in neurology at Mount Sinai Hospital in New York City and did her fellowship training in EEG and epilepsy at Mount Sinai Hospital and Yale University . She is also a member of the Foundation's professional advisory board.