The progestin-containing intrauterine device, also known as the coil, is a safe and well-tolerated form of contraception for women with epilepsy, according to a study published in the scientific journal, Epilepsia.
“Although popular among all women, complex drug interactions limit the efficacy and safety of oral contraceptives for [women with epilepsy],” the authors write.
They add: “Effective contraception enables women with epilepsy to plan their pregnancies and improve outcomes for themselves and their children.”
For the study, a team of researchers led by Dr Alison Pack, from Columbia University Medical Center, analysed 20 women with well-controlled epilepsy, who were on a stable antiepileptic drug (AED) regime. The AED most frequently taken amongst the group was lamotrigine. The average age of the women was 28, and 60% of them had not been pregnant before. All had experienced multiple seizures in the past.
The researchers measured the lowest (or ‘trough’) concentration of AED in the blood of the women before insertion of the coil, and again three weeks, three months and six months after. They did this because, for seizure control and AED safety to be maintained, it is important the level doesn’t change significantly.
The results showed that the lowest concentration of AED in the blood of the women remained stable during the six months following insertion of the coil.
The researchers also asked the women to record their seizures in a daily diary. They then compared the seizures that occurred during the month before insertion of the coil with those occurring in the six month following insertion.
During the month prior to insertion of the coil, 75% of the women did not have any seizures, whilst the remaining 25% had between one and three seizures.
After insertion of the coil, seizure frequency increased in three women, remained unchanged in 13 women and decreased in four women. Interestingly, none of the women said they felt a decrease in seizure control as a result of the coil.
The authors report that all participants were either “somewhat satisfied” or “very satisfied” with the coil, and that all participants continued to use it six months after insertion. They also confirm that no pregnancies occurred during the study.
These results suggest that the coil is an acceptable form of contraception for women with epilepsy.
Author: Dr Özge Özkaya
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A gluten-free diet could help control seizures in people with epilepsy who have celiac disease, according to a study published in the scientific journal Advances in Clinical and Experimental Medicine.
The researchers, led by Dr Mohammad Ghadami, at Kermanshah University of Medical Sciences, in Iran, studied 113 people with epilepsy in two Iranian hospitals. They first measured the levels of a protein called ‘anti-immunoglobulin A (IgA) antibody’ in their blood, which is indicative of celiac disease. They then took two to three small intestine biopsies from those tested positive for IgA antibodies, to confirm the presence of celiac disease. A total of seven people (6% of all those with epilepsy) were diagnosed with celiac disease in this way.
These seven people then received a gluten-free diet for five months and their seizure activity was recorded. The results showed that at the end of the five months, seizures were completely under control and antiepileptic drugs were discontinued for six of the seven subjects. For the remaining one paticipant, anticonvulsant drugs were reduced by half and seizures were controlled.
These findings suggest that people with epilepsy who have gastrointestinal symptoms should be screened for celiac disease, since the administration of a combination of a gluten-free diet and anticonvulsant treatment may be effective in treating them.
Celiac disease is a genetic autoimmune condition affecting the small intestine, which gets worse when gluten-containing foods such as wheat and its products are consumed.
Although the mechanisms underlying the association between celiac disease and epilepsy are not fully understood, some researchers have speculated that antibodies related to celiac disease may be toxic for neurons and trigger the development of epilepsy. A number of studies have shown that epilepsy can also develop in other immune-mediated conditions such as systemic lupus and myasthenia gravis.
Author: Dr Özge Özkaya
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