Which birth control is safe for a 29-year-old with seizures?

Question

Hello doctor,

My 29-year-old daughter started having seizures six months ago, right after starting birth control pills for irregular periods. She has had five grand mal seizures so far, and the neurologist diagnosed her with epilepsy.

The EEG showed generalized spike and wave activity, and the MRI was normal. She is on Lamotrigine 200 mg twice daily, but still has breakthrough seizures every few weeks. The birth control pills stopped, but her periods are even more irregular now. Sometimes bleeding for three weeks straight.

She had to drop out of college because she can not drive anymore and is depressed about losing her independence. Tried adding Valproic acid, but it caused terrible weight gain and hair loss, which made her depression worse. Her neurologist mentioned polycystic ovary syndrome might be related to her seizures, but I am not sure how.

She wants to go back on birth control to regulate periods, but is worried about triggering more epilepsy episodes. Is there a specific birth control that is safe with seizure medications? Also concerned about her having children someday with epilepsy.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

You should consult a neurologist for further advice and treatment. If you are taking antiepileptic drugs like Lamotrigine, it decreases the effect of estrogens, for the sake that you should start progesterone from intra-uterine contraceptive devices, such as tablet Primolute-N (Norethindrone) three times a day.

Yes, it can affect the baby if the seizure is uncontrolled and the attack of seizures increases during pregnancy. All women with antiepileptic drugs should be advised to take 5 mg/day of folic acid before conception and to continue the intake until at least the end of the first trimester to reduce the incidence of major congenital malformation.

Pre-pregnancy folic acid 5 mg/day may help reduce the risk of AED (anti-epileptic drugs) related cognitive deficits.

Early pregnancy can be an opportunity to screen for structural abnormalities. The fetal anomaly scan at 18-0 to 20-6 weeks of gestation can identify major cardiac defects in addition to neural tube defects.

One should be informed about the possible adverse impact on long-term neurodevelopment of the newborn following in utero exposure to sodium valproate. Based on limited evidence, in utero exposure to Carbamazepine and Lamotrigine does not appear to adversely affect the neurodevelopment of the offspring. There is very little evidence for Levetiracetam and Phenytoin. Sodium valproate has a cardiogenic effect on neural tube defects and cardiac defects.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.