Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Understanding Seizures: Their Impact on Women's Health and Hormonal Influences
Speaking of Women's Health Podcast Host Holly L. Thacker, MD focuses on the complexities of seizures and epilepsy in this episode. Dr. Thacker explores the types of seizures, causes, and treatment options with particular attention to women's health and hormonal influences.
• Explanation of seizures and epilepsy
• Overview of different seizure types
• Discussion on causes of seizures
• Impact of hormonal changes on seizure activity
• Importance of accurate diagnosis and treatment
• Emphasis on follow-up care and management
• Resources for further information on epilepsy
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the director of Speaking of Women's Health, and I am back in the Sunflower House for a new episode all about seizures. A new episode all about seizures. Seizures is a surge of abnormal electrical activity in the brain. It's also sometimes referred to as epilepsy, especially if it's a chronic condition. Um, some people can just have one seizure in their life because of fever or infection or trauma or some metabolic derangement, but if it's a chronic condition, it's generally referred to as epilepsy, and the most recognizable symptoms of a seizure are temporary loss of consciousness and uncontrollable movements of the body, which is termed convulsions. This can really be very dramatic and scary, but not all seizures look the same. Some people just stop what they're doing and just stare off into space for a few seconds. Others may have muscular jerks or lose control of the body. Some people, like I said, only have one seizure in their life, or others can have multiple seizures in a day. So the experience with seizures can be very different from others, and there's some important women's health aspects about seizures and seizure disorder, which is why we thought it would be very important to cover this. There's a number of different causes of seizures, because there's many things that can interfere with the brain's electrical patterns. This can range to rapid changes in blood sugar, illness, infection, injury or other neurologic conditions. Now there's two major types of seizures. Generalized seizures are electrical activity that starts in both sides of the brain and the body may shake. There might be some staring. It usually affects children or young adults, but it can occur at any age. Now focal seizures focal onset seizures are electrical activity that begins on one side of the brain and usually just affects one side of the body, and it may or may not affect someone's awareness and there can be physical emotional effects. There can be hallucinations, which is seeing things that aren't there, or hearing things that aren't there. About 60% of people with epilepsy have focal seizures, which also sometimes is called a partial seizure, and sometimes the symptoms of a focal seizure can be mistaken for signs of mental illness or other neurologic problems.
Holly L. Thacker, MD:Now the types of generalized seizure disorders include absence seizures, which means the person just stops what they're doing and stares. Atonic seizures, or drop seizures are when there's complete loss of muscle control and someone just drops right to the ground. Clonic seizures are shaking of the body and this involves sometimes just shaking on one side. Now, myoclonic seizures involves a quick jerk or twitch that can just affect certain muscle groups and then there is secondary generalized seizures. And if you have focal seizures, which is electrical activity that starts in one part of the brain followed by effects on the entire brain Tonic-clonic seizures the muscles can really stiffen, you can lose consciousness and then have convulsions and tonic seizures you may pass out and your muscles might tighten up, but you don't have full convulsions.
Holly L. Thacker, MD:Now the types of focal seizure disorders include focal onset aware seizures or simple partial seizures. You're aware of it when it happens and you're actually able to remember it. Focal onset impaired awareness seizures or complex partial seizures you really lose awareness and experience confusion when the seizure happens and you cannot remember what happened. So seizures can happen for many different reasons and they're not limited to the following Aneurysms, brain tumors, cerebral hypoxia or low oxygen level, cerebral vascular disorder, diabetes, severe brain trauma or concussions, especially one that involves loss of consciousness, degenerative brain diseases like Alzheimer's disease and frontotemporal dementia.
Holly L. Thacker, MD:In women who are pregnant, eclampsia is preeclampsia, or elevated blood pressure that progresses to seizures Anytime. Any person has any electrolyte abnormality, like low sodium, hyponatremia, changes in calcium levels or magnesium. Now epilepsy is when the person just has this brain condition without an identifiable cause. That can happen frequently without any underlying metabolic or brain substrate problem. Some genetic conditions may also predispose someone to seizures. May also predispose someone to seizures Now if there are hormonal related changes that can affect the excitability of the brain. And some young women with epilepsy may have their first seizures at the time of menarche because as the ovaries start to go through puberty and make estrogen, estrogen is brain stimulatory, whereas you need a functioning ovary and regular ovulation to make progesterone, and progesterone, which protects the lining of the uterus, prepares a fertilized egg for implantation, is more of a central depressant to the brain. Hence natural progesterone can cause sleepiness or relaxation, which is why when we prescribe it for menopausal women, we have them take it in the evening. Now, any kind of infection high fever, serious brain infections like encephalitis or meningitis can also cause seizures. Any severe inflammatory condition from autoimmune conditions can also trigger a seizure. If you didn't listen to my podcast at the beginning of season three on autoimmune conditions in women with Dr Al-Ghawi, that's a good one to go back to listen to Now.
Holly L. Thacker, MD:Mental health concerns, which are common, can sometimes predispose someone to what's called psychogenic seizures. So it's like a seizure but it's not a true electrical stimulation seizure and another term for this may be conversion disorder. Now, if there's problems with how the brain developed, like a congenital abnormality, injury with childbirth, any kind of trauma to brain tissue can cause scarring and be a focus of a trigger for this aberrant electrical activity that can cause a seizure. Certainly, toxins, poisons I mean carbon monoxide poisoning. It's odorless and if you've got car exhaust fumes or poorly vented areas. That's why all homes and workplaces should have carbon monoxide detectors, because this can cause death and before death may be seizures. Certain venomous bites or stings may also predispose someone to a seizure, to a seizure Certainly if you ever witness anyone having any unusual convulsive activity loss of consciousness, jerking, biting the tongue, losing control of bowels or bladder, which sometimes happens during seizures.
Holly L. Thacker, MD:Of course you want to assist the person, call 911, make sure that if they're vomiting, which occasionally happens, that they're over to their side so they're not inhaling the vomit, that they have an open airway, that there's fresh air, that they're not in some enclosed space where there could be carbon monoxide poisoning. Any person who experiences any change in consciousness or any possible seizure or convulsive disorder should, of course, go to the emergency room, emergency department, particularly if it is the first time. And anytime someone passes out, which isn't always a seizure, it could be syncope, low blood pressure, heart rhythm problems, medication side effects, drug intoxication, intentional or unintentional. And certainly if you are alone and you think you've had a first time event, then of course you should call 9-1-1 and contact your physician. Now, if you've had seizures in the past, it's important to watch for signs for another one and having a second seizure. Of course, even having a first seizure does require a medical evaluation, and the more seizures one has, the more likely it's that you'll have more seizures. So we generally want to treat them and prevent them.
Holly L. Thacker, MD:Now, childhood seizures if you're a parent or a grandparent taking care of young children, who can frequently develop infections quickly and high fevers that can really irritate the brain. But children can have seizures for many of the same reasons that adults have seizures and common types of childhood seizures that are included but are not limited to things such as absence seizures, which is childhood absence, epilepsy, febrile seizures are probably the most common and usually those go away. Infantile spasms, juvenile myoclonic epilepsy, tonic-clonic seizures there's a syndrome called Lennox-Gastaut syndrome and just being diagnosed with epilepsy, and probably epilepsy is considered one of the most common neurologic disorders and it's the fourth most common neurologic problem globally. So migraine eclipses it, stroke eclipses it and Alzheimer's disease eclipses it. If you haven't heard the podcast on migraine headache and you're one of the 50% of people with migraines, that's an important one to listen to. It's important to prevent migraine headaches because you want to have adequate blood flow to the brain. We've had several podcasts on memory and brain fog and signs of Alzheimer's disease and neuroprotective activities the MIND diet. So if you've missed those podcasts, diet. So if you've missed those podcasts, those are good ones to listen to.
Holly L. Thacker, MD:Stroke is like a brain attack and certainly if someone has neurologic symptoms slurred speech, inability to move a limb this is a medical emergency and you do want to call 911. Time is of the essence. There's all different types of strokes. It can be from a blood clot Atrial fibrillation is common, more common in women as they get older, particularly if they've had high blood pressure. And if you're in an irregular atrial fibrillation rhythm for more than 48 hours, you can have a tiny clot as small as the tip of a ballpoint pen that can cause devastating neurologic problems by blocking blood flow to that brain. There also can be lacunar infarcts, which are when the blood vessels, the tiny blood vessels, are not functioning well because of hypertension and this has a very characteristic appearance on CAT scan or MRI.
Holly L. Thacker, MD:So you have been listening to the Speaking of Women's Health podcast and I am your host, dr Holly Thacker. I'm in the Sunflower House talking all about seizure disorders and epilepsy, and this is very important in women because during pregnancy, women can be predisposed to preeclampsia, which is a metabolic problem. Elevated blood pressure and in severe cases of eclampsia or toxemia can be associated with seizures. Furthermore, the onset of menstruation, which usually brings more estrogen than progesterone, might be a time that epilepsy is manifested. And if you're a woman who has a stable epilepsy and you're going into menopause and thinking about hormone therapy, we usually want to make sure that there's enough progesterone on board and usually we just give progesterone to protect the uterus. And so women who don't have a uterus or an endometrium or endometriosis usually don't need progesterone.
Holly L. Thacker, MD:But sometimes, if I'm concerned, there's any hormonal stimulation to the brain, since estrogen is activating to the brain, which is why it's a mild mood elevator. It sometimes helps fatigue, helps antidepressant medicines work better, helps with word finding difficulties. There's estrogen receptors all throughout the brain. Anytime someone has any epilepsy or has had prior seizures, we want to be careful to not overstimulate the brain, and there's certainly medications that tend to be contraindicated in seizure disorder, like bupropion or Welbutrin. That's a common medication we use in perimenopause to kind of boost energy. It's used off-label to suppress the appetite. In higher doses it can be used for smoking cessation or treatment of depression. We use it off-label to boost dopamine, which sometimes will help with climax and sexual function.
Holly L. Thacker, MD:So in my practice of midlife hormonal menopausal medicine and anti-aging and preventive medicine, there's lots of overlaps with the brain and so it's very important to understand the functions and common neurologic problems and furthermore, generally speaking, in any neurologic condition the lack of estrogen usually makes things worse. Now, estrogen is not a treatment for Alzheimer's. I do have lots of neurologists send me patients who have neurologic problems, whether it's myasthenia gravis, which is an autoimmune condition, whether it's Parkinson's disease or multiple sclerosis, which is more common. The farther north one gets, and certainly the lower the vitamin D, the more likely someone is to have autoimmune conditions, and so those conditions tend to get worse. When a woman loses estrogen. Woman loses estrogen.
Holly L. Thacker, MD:So what is epilepsy? Well, it's a neurologic disorder in which a person, a male or female, has two or more just unprovoked, unexplained seizures that occur more than 24 hours apart. So an epileptic seizure is an event of altered brain function, which can be very scary, obviously, and it's caused by abnormal or excessive electrical discharges from brain cells. And epilepsy affects over three and a half million people in the United States and 50 million people worldwide. So we have about what 330 to 350 million people in the United States, so it's a relatively common condition.
Holly L. Thacker, MD:So you may know someone who has epilepsy, you may have epilepsy. So you may know someone who has epilepsy, you may have epilepsy. Or you may just want to know about it because you're interested in health and being healthy and being strong and being in charge, and it's kind of hard to be in charge when you're losing control of your consciousness and your body. So about 65% of newly diagnosed cases of epilepsy have no obvious cause, but of the remaining 35%, the more common reasons might be a stroke or some congenital abnormality. Those that we're just born with Brain tumor is always a concern, particularly in an adult, just out of the blue who has their first seizure.
Holly L. Thacker, MD:I mean they always have to be evaluated to rule out a brain tumor. History of trauma, infection, any ingestions of any substances has to be evaluated, and it's very important to determine the cause to help guide treatment. So how does a physician diagnose epilepsy? Well, it's aimed at identifying the type of seizure whether it's epileptic versus non-epileptic. The cause identifying the cause whether it's generalized or whether it's a partial, focal epilepsy, and then having the neurologist or the epilepsy specialist determine the best treatment option.
Holly L. Thacker, MD:And epilepsy types and causes are determined based on several things. First of all, the medical history, and this is true with any medical condition. You really want a proper diagnosis first to get the right treatment, and so a complete and accurate medical history is important. So your physician needs a very detailed description of your seizures as well as the sensations that you may feel before and after these episodes. Others who have often seen you either before, during or after the seizure, such as family members, close friends, should be accessible or present to give those historical details, especially if you yourself have lost consciousness, and your physician may ask you the following questions.
Holly L. Thacker, MD:So it's always good to be prepared anytime you go in for a health care encounter, anytime you go in for a healthcare encounter, do you experience a warning symptom or an aura before the seizure occurs? What's the first sign of your seizure? Do you lose consciousness? How long do your seizures last? How often do they occur? What factors, if any, seem to trigger your seizures? What age did you first develop seizures? What were the circumstances surrounding the first event? Have your seizures changed over time? What have been your prior treatments? What medications and doses have you taken? I mean, this is certainly something I recommend for all patients, regardless of whoever, whatever their conditions are.
Holly L. Thacker, MD:When you go and see a healthcare clinician, you should bring in all your medicines not pictures the actual bottles, patches, supplements. This is prescription and non-prescription, not just a list. Don't just say, oh, look in the computer, that's what's in there, because we really want to know exactly what you're on and when you take it. It's very important to know this and to be able to document it. You also want to know with any medical condition, including seizure disorder, is when were you optimized or fully controlled, and with any kind of treatment did you experience any unacceptable side effects? And also knowing details about your general health, as well as your biological family members' health. That's another thing when I'll ask questions. People might go on and on talking about their beloved father. That might have been the man that raised them and that they consider emotionally their father. But if it's not your biological father, biological mother or biological sibling, either full or half, then that doesn't really directly medically relate to your history. I mean, certainly, if it's an infectious disease and you've been around people with, say, tuberculosis, which there's been some outbreaks, for instance, or if you've been exposed to other people with infectious diseases, then of course that part of the history would be important. You need to be honest always when talking with your healthcare clinician about any alcohol use, drug use. It's also important for females to give information about their obstetrical history, their pregnancy, the delivery, the postpartum and newborn periods of time.
Holly L. Thacker, MD:Now the physical examination includes a neuromuscular evaluation of your muscle strength, your reflexes, your cranial nerves, eyesight, hearing, your balance, your cardiovascular system. Tests might include seeing a neurologist to undergo a detailed neurologic exam. Many times an EEG, which is an electroencephalogram, is done. This lasts about 90 minutes and it provides very important information many times about the type and the location of your epilepsy and it's a recording of brain waves done first by attaching small disc electrodes to measured locations on your head and these electrodes are then connected to recording devices called an electroencephalogram Now an MRI. A magnetic resonance imaging test is an advanced imaging test which takes about 15 minutes to an hour, and this allows your physician to uncover possible causes of your epilepsy. Mri uses magnetic and radio waves to generate a detailed of you of your brain, and so certainly if you have any electronic implanted devices pacemakers, artificial joints, I mean you're not allowed in the MRI room with anything that can be magnetized. Now blood tests can be also very helpful in evaluating your status, so various compounds and cells normally present in your blood, getting a good baseline of kidney and liver function.
Holly L. Thacker, MD:Many times after someone begins treatment with anti-seizure medicines, periodic blood tests need to be done. Sometimes levels of seizure medicines need to be done. Some anticonvulsant medications can affect bone health, so as an osteoporosis physician, I always inquire whether someone has been on dilantin or any seizure medicines that might affect vitamin d metabolism. Women contemplating pregnancy and breastfeeding need to have discussions to find out what are the safest types of medications that are seizure medicines that are used Now. You may not have epilepsy, but you still may have a physician prescribe epilepsy medicines. Many times, seizure medications. Mood stabilizing medications can be used for women with mood disorders. Medicines like Neurontin, which is gabapentin, and Lyrica, which is the brand name, or pregabalin, are used to treat pain conditions, fibromyalgia. Sometimes we use it off-label to treat hot flashes and sleep disorders. To treat hot flashes and sleep disorders, lithium is used in mood disorders and then Lamictal is also used in mood disorders, and these can certainly. Any type of medication that affects the brain may have effects on the developing fetus. So it's very important to plan pregnancies if you're on these medications and be monitored.
Holly L. Thacker, MD:Now, other tests maybe depend on your condition and not all neurologists specialize in epilepsy, so those that do are called epileptologists. They may recommend additional or more specialized tests or consultation, even with a neurosurgeon. Sometimes there is neurosurgical procedures or gamma knife procedures surgical, very localized procedures to remove a seizure focus very localized procedures to remove a seizure focus. A neuropsychologist may do memory testing. A neuro-ophthalmologist may need to be examining you, particularly if there's any involvement with vision, which is the occipital part of the brain, or the cranial nerve too. Sometimes you actually may need to see a geneticist for genetic assessment, and at the beginning of season three we had Ryan Noss come on talking about cancer genetics, but there are also a geneticist that specialize in neurologic problems, neurodegenerative problems, cardiovascular problems.
Holly L. Thacker, MD:Other tests may be considered, including an ictal single photon emission computed tomography, called ictal spec, and this is very interesting and it measures blood flow to the brain and how blood flow changes with seizure activity. A magnoencephalography, a MEG test, is an advanced method of recording and evaluating the brain while it's actively functioning, pinpointing abnormal changes in the brain. And then we have the PET scan positron emission tomography which is a procedure that shows changes in the brain metabolism that's associated with seizures. It certainly takes a lot of energy in the brain for this massive electrical activity in the brain. And then there is the SEG test, a stereo electroencephalography, which is a minimally invasive surgical procedure that places electrodes in the targeted brain areas and then they're monitored to precisely locate the exact source of the seizure. So this SEEG covers much more specific area than just a conventional EEG.
Holly L. Thacker, MD:So how is epilepsy treated? Well, the goal is to fully control seizures, restore your quality of life, eliminate the risk of premature death and in most cases success is achieved through accurate diagnosis and the choice of the right type and dosage of anti-seizure medicine. Sometimes epilepsy surgery may be considered if anti-seizure medicine fails to fully control seizures, and sometimes the surgery can be curative. In terms of medical treatment, the most important advice is to follow directions and take your medications exactly as directed, and to never suddenly change medicines or stop taking them without consulting your physician. And I tell people with any kind of potential life-threatening condition or any chronic medical condition that requires medication whether it's thyroid hormone medicine or osteoporosis medicine or cardiovascular medicine or seizure neurologic medicine that you should always have extra medicine on hand, so in case of supply chain problems or some disruption in your schedule. Also, you should plan in advance to always see your prescribing physician or their APP assistant, who can prescribe at least on a regular basis, certainly at least every year. In some conditions it might need to be more often.
Holly L. Thacker, MD:Now, the type of anti-seizure medicine you're given will depend on the type of epilepsy that you have, and the dose prescribed, of course, can vary with age, weight, gender and other factors, and certainly seizure medications can affect the bone. Some women that have seizures associated with menses might have their menses suppressed, and so we do see a number of women for hormonal consultations who have seizure disorders. With any medication, of course, there can be side effects and with anti-seizure medicines we have to be careful about sleepiness or unsteady gait. Usually they're mild and they pass, but certainly anytime you're started on a new medicine that can affect your brain you have to be careful about driving or operating machinery or mixing it with alcohol or drugs that also can affect your brain function. And having a good relationship with your medical team and knowing who to call and what to do if there's problems is always very good, because it's best to have a plan rather than having to rely on the emergency room. And it may take a couple of different attempts to find the right medicine and there might need to be a combination of medications and during this adjustment time period you may need to have blood samples taken to measure the seizure medication levels. But usually, once optimal treatment's found and factors in your life can change other medicines, other conditions, aging you still may need tweaks and adjustments.
Holly L. Thacker, MD:Now, surgical treatment is generally reserved for those people that are unresponsive to the standard anti-seizure medicines or people who just have intolerable side effects and to be considered for surgery. Obviously, extensive neurologic testing may need to be done to see if it's a localized area that can be surgically removed without causing damage to essential parts of the brain involved in movement, sensation, speech, vision and memory brain involved in movement, sensation, speech, vision and memory and surgery. Seizure-free rates after surgery can range from 30% to over 80%, depending on the patient's age and the location and the cause, and the principles of epilepsy surgery in infants and children, and adolescents and adults are similar. Epilepsy surgery in infants and children and adolescents and adults are similar, but in children, age-related factors such as cooperation and maturing brain changes, which can complicate the interpretation of both the EEG and the MRI, can pose additional challenges. On the other hand, pediatric patients can be best suited for epilepsy surgery, given they're still developing brains and they may be able to better adjust.
Holly L. Thacker, MD:After tailored surgical removal of the epileptic section of the brain, control seizures, including focused laser ablation, implantation of smart devices to detect and respond to seizures, which are typically referred to as responsive neurostimulation, and then stimulation of selected deep areas of the brain through DBS deep brain stimulation. In terms of follow-up, you have to be fully committed to regular follow-up, you and your caregivers. You need periodic exams and you need to be evaluated to see whether the medicine's working. If you're having side effects, you may need other testing, blood testing, other testing blood testing like blood count and chemistries, maybe potentially a bone density, possibly EEGs or MRIs or CAT scans. Now the Epilepsy Foundation is really a great resource if you or your family is looking for additional information, and they have a 24-7 helpline and their website, epilepsycom provides free tools and resources.
Holly L. Thacker, MD:And this concludes this podcast on seizure disorder and epilepsy, and I hope that you learned something and enjoyed listening to this episode and don't miss future episodes of our podcast. Be sure to subscribe to Speaking of Women's Health and you can subscribe anywhere you listen to podcasts Apple Podcasts, spotify, tune in wherever you listen and if you've enjoyed this and you want to support our podcast, please share it with others and give us a five-star rating. Remember be strong, be healthy and be in charge.
