Male and female brains are also different when it comes to epilepsy. And these differences are already formed during a pregnancy: thanks to the hypothalamus which is the cortical region that controls all our peripheral glands, the brain therefore differentiates into female and male.

The main difference can be found above all in the onset of epilepsy which can be different in terms of age of onset of the manifestations, although in reality the type of seizure is more or less always the same, and in the ability and sensitivity to respond to any drugs. In addition, neurotransmitters play an important role in our brain, including hormone receptors that can modify electrical activity and facilitate the onset of seizures; for this reason in women crises can occur more easily in the premenstrual period and in the ovulation period. The incidence of epilepsy is slightly higher in men than in women, regardless of country of origin.

This gender difference could be due to the genotype, to a different prevalence of risk factors in the two sexes or to the concealment of the pathology in women for socio-cultural reasons. Epileptic seizures break into daily life in both sexes and have a significant impact in school, work and society, especially in the lives of women, due to their central role in childcare. Furthermore, the use of anti-seizure drugs can have a negative impact on hormonal and reproductive levels: menstrual cycle, use of contraceptives, pregnancy, fetal health and breastfeeding. Regarding the response to drugs in women and men, the studies currently available have not yet shown significant responses.

“Although there is no scientific evidence – explains Laura Tassi, President of LICE, the Italian League against Epilepsy and Chief Medical Officer in Epilepsy and Parkinson’s Surgery at the ASST Grande Ospedale Metropolitano Niguarda (Milan) – we can say that probably the answer to drugs in women and men is the same. As doctors our difficulty lies above all in the therapeutic choice, because drugs can modify the hormonal balance especially in women and cause, for example, a polycystic ovary which contributes to reducing fertility in long-term, although we know that the proportion of women who have epilepsy-associated polycystic ovary is much higher overall and is independent of medication.” The pharmacological approach is the first treatment strategy and is therefore based on the regular administration of anti-seizure drugs which, with various mechanisms, stabilize the electrical properties of the nerve cell membrane. The drug intake is daily and it is essential that it be regular and constant, the sudden interruption of the drug could cause the onset of crises.

“Epilepsy is surrounded by many prejudices – intervenes Oriano Mecarelli, LICE Past President – and this implies that, also from a social point of view, there are serious repercussions: people with epilepsy, still today, suffer discrimination at school, on the work and in many other contexts. This strongly penalizes their quality of life. If intervention is made with a correct and early diagnosis and adequate therapy, the pathology can be kept under control in about 70% of cases, but it still remains to be addressed 30% of drug-resistant forms. Furthermore, there are some data in the literature documenting that women with epilepsy are more subject to violence and discrimination, even in the family environment and that women who have suffered sexual violence in adolescence may present more frequently psychogenic non-epileptic seizures, but they are often misdiagnosed and treated as seizures. Moreover, women with epilepsy experience have more difficulty than the others in carrying on stable emotional relationships and, on average, have fewer children”. These are the 10 most frequent fears in women with Epilepsy, to which the Lice answers: – Can Epilepsy or drugs for Epilepsy cause menstrual cycle irregularities? Menstrual irregularities could be partly associated with an increased frequency of polycystic ovarian syndrome in women with epilepsy under treatment, although not confirmed by all studies. – Epilepsy and anti-seizure drugs interfere with sex life? People with Epilepsy report sexual disturbances more frequently. Some drugs that interfere with sex hormones have been implicated in causing a less satisfying sex life in men and women. It is also possible that drugs with a more “sedative” effect on the central nervous system reduce cravings. – Does epilepsy affect fertility? Studies have shown that women and men with epilepsy become parents less frequently. A slight reduction in fertility, due to a direct effect of seizures or anti-seizure drugs on reproductive hormones, and psychological and social factors may be implicated. Furthermore, there are important differences related to the type of epilepsy and any associated disorders that can influence the intention to become parents.

Is it possible to use a hormonal contraceptive? Combined contraceptives (estrogens and progestogens) interact with some medications. This leads to a reduction in contraceptive efficacy. This applies not only to the “pill”, but also to the plaster and vaginal ring forms. – Is Epilepsy genetically transmissible? Epilepsy is very rarely genetically determined and transmissible to one’s children. – Can anti-seizure drugs cause birth defects? The drugs can be teratogenic, thus inducing malformations. A pregnancy is possible but must be planned. In the 3-4 months before the beginning of each pregnancy, folic acid must be taken, which is a neuroprotector and it is important to choose suitable drugs in order to have a pregnancy in which the risks are more or less equal to those of women who do not suffer from Epilepsy. You should always contact your epileptologist or the main epilepsy and pregnancy centers. – In menopause or in pregnancy, will the trend of the crises change? The effects of menopause and pregnancy on crises are not always predictable and these can increase, decrease or remain unchanged. Women who have always had a tendency to have seizures in the menstrual period may have an increase in seizures just before menopause, and then experience, usually a decrease after menopause has definitively established. – Is it possible to take hormone replacement therapy or are there any contraindications? There are no absolute contraindications to hormone replacement therapy, however it should be borne in mind that it has been reported that this can be associated with a worsening of crises in some circumstances and, above all, in some high-dose formulations. – Is there an increased risk of osteoporosis due to the disease or the anti-seizure drugs? The risk of osteoporosis is increased by 2-3 times in people with epilepsy, in relation to the use of certain drugs. – Are there any special recommendations for bone health in people with epilepsy? In general, the recommendations are those that apply to the entire population: a balanced diet rich in calcium and vitamin D, maintaining a healthy weight, regular physical activity, possibly in the open air, avoiding alcohol and smoking.

With over 50 million people affected worldwide, epilepsy is one of the most widespread neurological diseases, which is why the World Health Organization has recognized epilepsy as a social disease. It is estimated that in industrialized countries it affects about 1 in 100 people: in Italy about 600,000 people suffer from Epilepsy, as many as 6 million in Europe. In high-income countries the incidence of epilepsy has two peaks, respectively in the first year of life and after the age of 75: in Italy it is estimated that 86 new cases of epilepsy occur every year in the first year of life, 20-30 in youth/adulthood and 180 after the age of 75.