Women with epilepsy face a variety of unique challenges, particularly with respect to reproductive health. Sex hormones can impact brain function and influence seizures through all life stages, from puberty through menopause. A significant number of women have catamenial epilepsy, or seizures that occur during distinct phases of the menstrual cycle. During pregnancy, hormone alterations can alter the metabolism of anti-seizure medications and seizure risk
The Women’s Epilepsy Program at Brigham and Women’s Hospital addresses the very specific needs and concerns of women with epilepsy, especially in regards to pregnancy planning and management throughout pregnancy. The program is composed of an interdisciplinary team that includes neurologists, neurosurgeons, obstetrician-gynecologists, neuropsychologists, and psychiatrists, all with specialized interest and extensive backgrounds in women’s epilepsy. This special program was created to provide leading-edge neurological and obstetrical clinical care, psychological support, counseling, and education based on the latest research on anti-seizure medication use in women with epilepsy.
The women's epilepsy team is led by Emma. P. Voinescu, MD, PhD. Other team members include Regan Jo Lemley, MD, MS, Stephanie R. Allien, PA-C, Erin Farina, RN, and rotating fellows and residents. This core team meets weekly to supervise current pregnancies in women with epilepsy. Thomas McElrath, MD, PhD is an experienced Maternal-Fetal Medicine specialist, with expertise in treating women with neurological conditions, who works closely with the epilepsy team.
Paula E. Voinescu, MD, PhD: Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type Voinescu PE, Ehlert AN, Bay CP, Allien S, Pennell PB. Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type. Neurology. 2022 Feb 22;98(8):e802-e807. doi: 10.1212/WNL.0000000000013056. Epub 2021 Dec 10. PMID: 34893557; PMCID: PMC8883510.
Dr. Voinescu and colleagues sought to assess whether increased seizure frequency during pregnancy and postpartum period is more likely in women with either focal or generalized epilepsy and if it differs by the localization of seizures. The results of the study found that women with focal epilepsy have higher rates of seizure worsening during pregnancy compared to women with generalized epilepsy, and women with frontal lobe epilepsy have particularly elevated rates of seizure worsening during pregnancy and postpartum.
"The Case of the Restless Sleeper," published in Boston Magazine.
Voinescu PE, Park S, Chen LQ, Stowe ZN, Newport DJ, Ritchie JC, Pennell PB. Antiepileptic drug clearances during pregnancy and clinical implications for women with epilepsy. Neurology. 2018 Sep 25;91(13):e1228-e1236. doi: 10.1212/WNL.0000000000006240. Epub 2018 Sep 5. PMID: 30185446; PMCID: PMC6161546.
At the American Epilepsy Society's annual meeting in New Orleans, Louisiana, Paula E. Voinescu, MD, PhD, junior faculty at Brigham and Women's Hospital and instructor at Harvard Medical School, spoke about a new study where Voinescu and colleagues sought to assess whether increased seizure frequency during pregnancy and postpartum period is more likely in women with either focal or generalized epilepsy and if it differs by the localization of seizures. The results of the study found that women with focal epilepsy have higher rates of seizure worsening during pregnancy compared to women with generalized epilepsy, and women with frontal lobe epilepsy have particularly elevated rates of seizure worsening during pregnancy and postpartum.Watch the video about Paula E. Voinescu, MD, PhD: Seizure Frequency in Pregnancy, Postpartum
Paula Voinescu, MD, PhD and Regan Lemley, MD, MS answer questions about living with Epilepsy during pregnancy.Watch the video about Planning for a Healthy You and a Healthy Baby- Brigham and Women's Hospital
For women who are contemplating pregnancy or who are pregnant, we offer comprehensive management that begins with choosing the best medication regimen at the right doses to control seizures while posing the lowest possible risk to the developing baby. This requires a delicate balance that necessitates regular antiseizure medication blood concentration monitoring and frequent follow-up with our specialized physicians.
Our program provides ongoing monitoring throughout pregnancy and delivery, counseling on all pregnancy and delivery related concerns, from the right supplementation to special issues surrounding delivery, breast feeding and motherhood. Brigham and Women’s Hospital is world renowned for the quality of our obstetrical and neonatal care and is dedicated to the most wide-ranging state-of-the-art obstetrical services under one roof in the country.
The Women's Epilepsy Program also serves as an international hub for the latest research studies into the complex interactions between female hormones and the brain, seizure medications, pregnancy and the full range of concerns unique to women, including:
BWH Epilepsy-Ob clinic has been a major center in recruiting for the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD), the largest prospective cohort study of pregnant/postpartum women with epilepsy. We are also supporters of My Epilepsy Story, a non-profit organization that serves to bridge the gap for women and girls diagnosed with epilepsy and their families, as well as the children impacted by their mother’s epilepsy by Collaborating, Advocating, Researching, and Educating (C.A.R.E.) about women’s health and epilepsy. Dedicated physicians are constantly expanding on up-to-date educational materials posted on their website.
The Epilepsy Foundation of New England has supported so many of our patients, mothers with epilepsy and their children, to navigate the systems in challenging situations, coordinate their care and help them plan for a better tomorrow. They are also supporting our center to contribute to the efforts of the The Epilepsy Learning Healthcare System for physicians and patients to better work together.
Brigham and Women's Hospital is affiliated with the North American Antiepileptic Drug Pregnancy Registry, the largest U.S. research program to date aimed at identifying the safest drugs for pregnant women with epilepsy and their unborn babies. More information can be found here.
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