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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In Connecticut, physicians followed 19 women with tractable epilepsy for 3-5 months to determine baseline seizure frequency. 14 women agreed to enter a clinical trial evaluating synthetic medroxyprogesterone acetate's (MPA) ability to reduce seizure frequency by adding MPA to the usual antiepileptic drug regimen. They all received 10 mg MPA pills 2-4 times each day. 6 women who did experience amenorrhea later received 120-150 mg intramuscular MPA injections (Depo-Provera) every 6-12 weeks instead of oral MPA. The physicians followed the women for 12 months. 11 women eventually experienced amenorrhea and always had low levels of serum progesterone ( or = ng/ml). Seizure frequency fell significantly from a mean of 8.3 seizures/month before MPA administration to 5.1 seizures/month after MPA administration, equaling 39% fewer seizures (p = .02). 7 women who experienced obvious improvement had 52% fewer seizures on average (25-71%) reduction. All women who had fewer seizures did experience partial seizures, however. MPA did not affect the steady state levels of antiepileptic drugs. MPA levels were higher in women receiving oral MPA than they were in those receiving MPA injections (5.2 ng/ml vs. 2.6 ng/ml). Most women had some spotting, particularly during the first few months of the study. Some of these women discontinued treatment because of this side effect, especially women who did not appear to benefit from the treatment. Menstruation returned in 6-12 months in women receiving MPA injections. Further research on MPA's effect on catamenial seizures is needed.
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PMID:Treatment of seizures with medroxyprogesterone acetate: preliminary report. 654 Apr 15

A leading patient complaint is headaches which tend to occur more often in women than men. Nonvascular headache is the most common and is caused by tension or muscle contraction. Oral contraceptives (OCs) do not affect nonvascular headaches. They can also be safely used in women who experience common migraines whose symptoms do not become more severe or frequent during OC use. On the other hand, women who have classic migraine (headache accompanied by focal neurologic symptoms) or common migraine with symptoms becoming more severe or frequent during OC use should discontinue OC use. Instead, they should use a barrier method or the IUD. Estradiol treatment appears to be effective in treating menstrual migraine. Since the data are inconclusive about the effect of OCs on young women who have experienced a stroke or transient ischemic attacks, it would be best for them to use a barrier method. Most antiepileptic drugs (phenobarbital, phenytoin, paramethadione, and carbamazepine) cause enzyme induction which may be linked to decreased levels of estrogen and increases in irregular bleeding, thereby increasing the likelihood of an epileptic OC user becoming pregnant. Possible contraceptive failure exposes a developing fetus to the teratogenic properties of the antiepileptic drugs. Thus, physicians should prescribe OCs with 50 mcg of ethinyl estradiol rather than 35 mcg ethinyl estradiol. Epileptic women can also use Depo-Provera, because it is not only effective in preventing pregnancy but reduces seizure frequency. It is important for any contraceptive method chosen for epileptic women to be effective because pregnancy intensifies seizures which in turn can damage the mother and/or fetus and cause neonatal distress.
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PMID:Contraceptive methods for women with neurologic disorders. 851 48

US teenagers have had access to the injectable contraceptive depot medroxyprogesterone acetate (DMPA; Depo-Provera) since the US Food and Drug Administration approved it in 1992. DMPA suppresses follicle stimulating hormone and luteinizing hormone (LH) levels, which in turn prevents the LH surge and thus inhibits ovulation. It also causes a thick cervical mucus (reducing sperm penetration). Since DMPA also changes tubal mobility and creates shallow and atrophic endometrium, implantation is prevented. DMPA must be administered every 3 months to be effective. Its first-year failure rate is 0.3%, which is lower than that of oral contraceptives (3%). Advantages of DMPA are that it: allows for privacy; improves compliance (since action is required every 3 months rather than every day); has no estrogen-related complications (e.g., thrombophlebitis); is effective; is safe for breast feeding teenagers; reduces seizure frequency in teenagers with epilepsy; has a favorable effect on sickle cell disease or coagulopathy; reduces menstrual flow, thus preventing iron-deficiency anemia; reduces menstrual pain and pre-menstrual symptoms; and decreases risk of pelvic inflammatory disease. The leading disadvantages are menstrual irregularities and spotting. Some other possible disadvantages include weight gain (most common reason for discontinuation), delayed return of fertility, headaches, acne, and nervousness. Health providers must perform a complete history of teenagers requesting DMPA. They should determine the presence or absence of absolute and relative contraindications to DMPA. Absolute contraindications are known or suspected pregnancy, undiagnosed or abnormal vaginal bleeding, known or suspected history of breast cancer, acute liver disease or jaundice, thromboembolism, and sensitivity to DMPA. DMPA is administered intramuscularly at a concentration of 150 mg/ml. Health providers need to use a frank, nonjudgmental, empathic, and unhurried approach to facilitate a trusting relationship and rapport with teenagers. Advanced counseling on the pros and cons of DMPA, how DMPA works, and DMPA's inability to protect against sexually transmitted diseases is essential.
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PMID:Use of depo-provera in teens. 892 Mar 51

Finding the most appropriate contraceptive method for retarded or developmentally delayed young people poses a tremendous challenge to family planning nurse practitioners. Retarded young people have the same sex drive and are influenced by the same pressures affecting sexual decision making as every adolescent. The crucial difference is the retarded person's lack of appropriate information about physical and emotional changes of adolescence, sexuality, and birth control. Since retarded teenagers struggle to be accepted, they tend to be compliant and thus vulnerable to sexual exploitation. Parents are generally more concerned about sexuality in retarded daughters than sons, and many request to have their child sterilized. Mentally retarded teens usually lack the motor skills and motivation to use barrier methods consistently. Long-acting injectable contraceptives such as Depo-Provera offer the greatest protection against pregnancy and have the highest satisfaction rate among parents and caretakers of retarded young people; however, side effects can include depression and weight gain. If hormonal contraception is selected, its effects on seizure activity must be carefully evaluated. In addition, may epileptic teens may be on anticonvulsants or other medications that interfere with the effectiveness of hormonal methods. Sterilization must be approved by the courts and is difficult to obtain if a young woman demonstrates enough comprehension and competence to one day marry and have a family.
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PMID:Physically, mentally disabled teens require special contraceptive care. 1226 27

Norplant, Depo-Provera, and the progestin-only pill are good for 35-50 year old women, since they are safe and have low failure rates. A beneficial feature of progestin-only contraceptives is the lack of thrombotic complications. They are good for couples considering sexual sterilization. Neither antibiotics nor antiseizure medicines reduce Depo-Provera's effectiveness. The only drug which reduces its effectiveness is aminoglutethimide (Cytadren), used to suppress adrenal function in some people with Cushing syndrome. Research indicates that Depo-Provera even reduces the frequency of seizures. Antiseizure medicines (except valproic acid) and the antibiotic, rifampin, greatly reduce the effectiveness of Norplant to prevent pregnancy. Antiseizure drugs increase hepatic enzymes, resulting in the breakdown of levonorgestrel. In those cases where women who already have Norplant need an antiseizure drug or rifampin, family planning practitioners should advise them to use another contraceptive. Many women using Depo-Provera experience amenorrhea (30-50% at 1 year, 70% at 2 years, and 80% at 5 years), but most find it to be a benefit. The most undesirable side effect of Depo-Provera is weight gain (5.4-16.5 lbs. after 1-6 years use, respectively), likely due to increased appetite. Women who use Norplant for 5 years gain on average a little less than 5 lbs. Once a woman is injected with Depo-Provera, she cannot immediately discontinue it, and its effects cannot be stopped. It takes 6 to 8 months to clear the body. Only 2 women have experienced anaphylactic reactions to Depo-Provera. Despite this rare event, it is important for practitioners to have epinephrine, steroids, and diphenhydramine to treat severe allergic reactions. A study finds reduced bone density among longterm Depo-Provera users, but it did not match for parity or smoking and did not determine bone density prior to injections of Depo-Provera. Further research on bone density and progestin-only contraceptives is needed.
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PMID:Ask the experts: progestin-only contraceptives. 1228 99

Anticonvulsant drugs used to treat epilepsy have been linked to an increased risk of birth defects among infants of epileptic mothers. Thus, effective contraception for epileptic women is especially important. Copper IUDs, voluntary sterilization, and correct use of barrier methods have been suggested. Most hormonal methods raise concerns, however. Some antiepileptic drugs (e.g., phenytoin, phenobarbital, carbamazepine, and paramethadione) may cause more rapid metabolism of the progestin or estrogen component of combined oral contraceptives. This, in turn, may reduce contraceptive effectiveness, resulting in pregnancy and exposure of the fetus to the potential teratogenic properties of the anti-seizure drug. Since anticonvulsant drugs also speed the metabolism of levonorgestrel, Norplant is not recommended for epileptic women. Depo-Provera is an appropriate method for epileptic women and may reduce seizure frequency.
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PMID:Epilepsy drugs may reduce method effectiveness. 1229 55