HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Harden, C. L. Search for Related Content PubMed PubMed Citation Articles by Harden, C. L.

Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Menopause and bone density issues for women with epilepsy

From the Comprehensive Epilepsy Center, New York–Presbyterian Hospital—Weill Medical College of Cornell University, New York, NY.

Address correspondence and reprint requests to Dr. Cynthia L. Harden, Comprehensive Epilepsy Center, Room K-615, New York–Presbyterian Hospital—Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021.

Menopausal women with epilepsy present several unique management challenges. They have an elevated risk for osteoporotic fracture because of the adverse effects of antiepileptic drugs (AEDs) on bone metabolism, combined with the chance of trauma during seizures and the subtle effects of AEDs on coordination that promote falling. A uniform effect of AEDs on vitamin D metabolism or bone turnover has not yet been revealed by clinical or basic studies, although the enzyme-inducing AEDs appear to decrease serum vitamin D levels. However, bone density is frequently decreased in patients with epilepsy. Clinicians must be familiar with the recommendations for calcium and vitamin D supplementation and recognize when to refer patients for bone density evaluations. Perimenopause is a transition during which women with epilepsy are at risk for increased seizure frequency, probably because of alterations in the estrogen:progesterone ratio over this period. Women with epilepsy who have had a catamenial seizure pattern during their reproductive years are at particular risk for an increase in seizure frequency during perimenopause but may experience a seizure reduction after becoming menopausal (cessation of menses for 1 year). These women appear to represent a subgroup of patients with epilepsy who have heightened sensitivity to endogenous reproductive hormone levels. The use of hormone replacement therapy may also increase seizure occurrence. Finally, the age at menopause may be reduced in women with poorly controlled seizures. This is probably related to an effect of seizures on hypothalamic function, although primary ovarian dysfunction may also be operative in this setting.

This article has been cited by other articles:

				R. D. Sheth, N. Binkley, and B. P. Hermann Progressive bone deficit in epilepsy Neurology, January 15, 2008; 70(3): 170 - 176. [Abstract] [Full Text] [PDF]

				G. Montouris Importance of monotherapy in women across the reproductive cycle Neurology, December 11, 2007; 69(24_suppl_3): S10 - S16. [Abstract] [Full Text] [PDF]

				M. Jackson Epilepsy in women: a practical guide to management Practical Neurology, June 1, 2006; 6(3): 166 - 179. [Full Text] [PDF]

				M D O'Brien and S K Gilmour-White Management of epilepsy in women Postgrad. Med. J., May 1, 2005; 81(955): 278 - 285. [Abstract] [Full Text] [PDF]