Managing women with epilepsy

Guideline producers now need to pay attention to implementation

In the mid-1800s Sir Charles Locock first used the earliest antiepileptic drug of modern times, potassium bromide, to treat a group of women with catamenial epilepsy. Such gender selection unintentionally pointed to the future recognition that gender matters in epilepsy. We now know about important interactions between epilepsy and its treatment and women's sexuality, conception, pregnancy, motherhood, and menopause; we also know that the offspring's health and heredity may be affected. Literature for clinicians on women with epilepsy has grown steeply in recent years. The Medline database alone contains over 40 review articles published in English in the past 25 years, almost half of which were published within the past five years. Has this expansive literature resulted in better care for women with epilepsy?

The evidence suggests that information has been slow to influence clinical practice. European and American surveys consistently show that clinicians either lack familiarity with or fail to advise epileptic women on issues as common as contraception, drug interaction, and teratogenicity.1^–3 Clinical practice guidelines are an attempt to bridge the gap between evidence and …