Women and Epilepsy: Taking Care of Yourself

Joyce Liporace, M.D.Jefferson Medical CollegeDepartment of Neurology

Today’s Topics

• Bone Health

• Sleep

• Exercise

• Nutrition

• Vitamins and Mineral

• Herbal Medicines

Bone Health- Why should you care?• People with epilepsy are at increased

risk for osteoporosis and fractures.

• Bone loss is increased by medications that you take to reduce seizures.

AEDs are associated with Bone Disease• Bone loss and fracture were reported

with Phenobarbital, Mysoline, and Dilantin in the 1970’s

• Bone loss and fracture have more recently been reported with Tegretol and Depakote

• The new drugs have not been studied (yet)

Bone Health

• The epilepsy drugs reduce levels of Vitamin D

• This leads to decreased absorption of dietary calcium, increased parathyroid hormone and causes bone loss

Bone Health

• Women reach peak bone mass by age 25.

• After age 25, we lose 1% of bone each year, until menopause.

• With menopause, women lose 4-5% of bone each year.

• Over a lifetime, women lose 45% of vertebral bone and 55% of their femur.

Bone Health-Risk Factors

• Gender

• Race

• Limited weight-bearing exercise

• Low dietary calcium

• High protein, alcohol, caffeine intake

• High soda consumption

Bone Health

• Few patients with risk factors for bone disease are offered screening.

• If diagnosed early, metabolic bone disease can be reversed with treatment and fractures may be prevented.

Bone Health Screening

• DEXA scan (dual X-ray absorptiometry)• It takes less than 10 minutes, no needles.• Bone mineral density (BMD) of spine and

hip are compared to gender matched controls at peak bone mass.

• There is a 50% increase in fracture for every SD below normal bone

Bone Health

• Metabolic bone disease is common in adults with epilepsy.

• Both men and women are affected.

• We suggest screening epilepsy patients with a DEXA scan, after a treatment duration of two years, earlier for those with a low body mass index or other risk factors.

Bone Health-Treatment

• Calcium 1,200-1,800 mg/day and Vitamin D 800 IU/day.

• Exercise is important!

• A repeat DEXA scan should be done after 18 months.

QUIZ

• How much calcium (mg) is in the following?:

• Yogurt, nonfat, plain, 8 oz

• Skim milk, 8 oz

• Sardines in oil, drained, 2 oz

Bone Health-Suggestions

• Ask your Doctor for a DEXA scan

• Make sure you are getting enough Calcium and Vitamin D

• Stop drinking soda (or at least limit it)

• Exercise more

Sleep

• Sleep may affect seizures• Quality sleep is essential for patients with

epilepsy• Going for long periods without sleep can

increase seizures• Sleep disturbance can lead to: daytime

drowsiness, worsening memory, poor seizure control

Sleep

• During sleep, brain waves become very rhythmic. Some people will have seizures only during sleep.

• Sleep can activate seizures and abnormal brain waves-that is why your doctor may order a sleep deprived EEG.

Sleep

• The older epilepsy medications affect sleep architecture-they reduce the deeper stages of sleep. The newer drugs may be less disruptive. A change in dosing schedule may help sleep.

• Many medications can affect sleep!

Sleep Suggestions

• Take to your doctor about your sleep

• If you snore or have disturbed sleep, you may need a sleep study

• In some cases, diagnosis and treatment of a sleep disorder can alleviate seizures

Sleep Suggestions

• Try to avoid sleep deprivation• Determine how much sleep is “adequate”

for you • Have good sleep “hygiene”-with an

evening routine.• Avoid caffeine in the afternoon and

evening• Avoid late afternoon naps

Exercise

• Being physically fit is good for everyone!

• Jogging, tennis, golf, basketball, softball… there are many activities that people with epilepsy can enjoy (safely).

• Some caution is needed: water skiing, scuba diving, sky diving, boxing, swimming.

Exercise

• 12 Week Study Exercise Program for Epilepsy Patients:

• Supervised Exercise program three times a week

• Improved Quality of Life in the exercise group and seizures were not affected (McCauley 2001)

Exercise and Seizures

• Precipitation of seizures by exercise has been described, but it is unusual

• Be aware of: prolonged hyperventilation (yoga, pilates), increased body temperature

Exercise Suggestions

• Avoid strenuous exercise and know your limitations.

• Take frequent breaks.• Never swim alone and always inform

others that you have seizures.• Use adequate head protection.• Avoid sports with a high risk of head

injury.

Nutrition

• It is important to eat a balanced diet and have meals at regular times

• It is very rare for nutrition to cause a seizure but can be seen with very low blood glucose, low levels of sodium (water intoxication), calcium, magnesium, and low levels of Vitamin B6 in babies.

Vitamins

• Vitamins are chemicals that are required in tiny amounts to maintain normal cell function.

• Some are made by our bodies, others are made by plants or animals.

• The only Vitamin deficiency known to cause seizures is Vitamin B6, pyridoxine.

Vitamins

• Epilepsy medications may interact with vitamins in the body.

• The older medications reduce Vitamin D which lowers calcium absorption.

• The older drugs may also reduce Vitamin K levels which are important for blood clotting.

Epilepsy Medications and Folic Acid• Some epilepsy medications reduce folic

acid.• Folic acid is important for blood cell

production and for peripheral nerve function.• Low folic acid increases the risk of birth

defects.• Women of child bearing age should take

extra Folic acid.

Minerals

• Minerals are essential nutrients.• Low levels of some minerals (calcium,

sodium, magnesium) can affect electrical activity of the brain.

• Deficiency of minerals in the diet are rare.• Selenium and Zinc may help to counteract

side effects of some medications (hair loss from Depakote)

Calcium Requirements

• Average Calcium intake for adult women in the US is 800 mg/day

• The requirement is 1,200 to 1,800 mg/day.

• We only absorb 600 mg at a time.

Magnesium

• Low levels of magnesium may lead to seizures (and headache).

• Low magnesium can lead to low calcium.

• It is rare to need magnesium replacement, unless you have a poor diet or chronically abuse alcohol.

Herbal Medicines

• Herbal products in the US are considered dietary supplements are are not regulated as medicines.

• 30% of Americans use complementary or alternative medicines

• Their use can pose serious health risks

Omega-3 Fatty Acids

• Fish oils

• Reduced seizures in patients that consumed 5 grams of spread at every breakfast for 6 months. (Schlanger, Epilepsia 2002)

• 21 patients-16 patients refused to eat the spread!

Herbal Medicines to Avoid

• Ephedra or Ma Huang

• Caffeine

• Gingko

• Ginseng

• St. John’s Wort (may alter drug levels)

• Evening Primrose

• Borage

Resources available for women with epilepsy• Epilepsy Foundation of America

www.efa.org

• American Epilepsy Society www.aesnet.org

• National Osteoporosis Foundation www.nof.org