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Neuroscience Module > 85b - Neurological Diseases in Women > Flashcards

85b - Neurological Diseases in Women Flashcards

1
Q

Which hormonal fluctuations are likely to affect seizure frequency in women with epilepsy?

A

More estrogen + less progesterone -> more seizures

(Increased estrogen:progesterone ratio)

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2
Q

An abrupt drop in estorgen levels may trigger…

  1. Epileptic seizures
  2. MS flares
  3. Menstrually related migraines
A

Menstrually related migraines

  • Rapid withdrawal of estrogen may trigger migraine
  • May happen just before menstrual period, postpartum, or perimenopause
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3
Q

How do sex hormones influence the course of MS?

A

Estrogen (E2) -> Th1 phenotype -> Inflammatory -> MS predisposition

Note: E3 estrogen released in pregnancy leads to Th2 phenotype, MS remission

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4
Q

How does progesterone influence epilepsy?

A

Progesterone increases seizure threshold

  • Potentiates GABA
    • -> Increased general inhibition
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5
Q

What happens to migraine in pregnancy?

A
  • Migraines unusual in 1st and 2nd trimester
    • Estrogen slowly increasing
  • Increase during 3rd trimester, postpartum
    • Rapid withdrawal of estrogen
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6
Q

Valproic acid should be avoided in which population

A

Women of childbearing age

Find soemthing else to treat migraine or epilepsy in anyone who might have a child!!

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7
Q

Which AED is most affected by changes in drug metabolism during pregnancy?

A

Lamotrigine

  • Glucuronidation is facilitated by estrogen
  • -> Faster drug metabolism during pregnancy
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8
Q

Rapid withdrawal of which hormone is might trigger a migraine in a suceptible individual?

A

Estrogen

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9
Q

If a patient with MS needs a disease-modifying agent during pregnancy, which one should you use?

A

Glatimer acetate

BUT, avoid DMAs in pregnancy if possible; MS flares are liekly to decrease due to increased E3 estrogen

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10
Q

If a patient is having higher estrogen and lower progesterone, are they more or less likely to have seizures?

A

More likely

(More estrogen + less progesterone -> more seizures)

  • Estrogen (E2) -> more seizures
  • Progesterone -> fewer seizures
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11
Q

How does pregnancy affect MS?

A

Women with MS are likely to remit during pregnancy

  • E3 estrogen released in pregnancy
    • -> Th2 phenotype (less inflammatory, increased immune tolerance)
    • Fewer MS flares
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12
Q

What is the best mode of contraception for a young woman with migrain with aura?

A

IUD

(In general, seems like the best option for all people discussed in this lecture)

  • Combined oral contraceptive pills and migraine with aura both increase risk of stroke; together, result in 7x increased risk
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13
Q

What happens to migraine frequency during menopause?

A
  • More migraines during menopause as estrogen levels rapidly fall
  • Much lower frequency of migraines after menopause
    • Estrogen is lower, but at a steady state
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14
Q

Many AEDs are enzyme inducers - what are the implications for patients taking oral contraceptive pills?

A

Less bioavailability of OCPs

Notably, OCPs also decrease bioavailability of lamotrigine

  • Recommend IUD, depo-provera, or condoms
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15
Q

Which hormone is associated with decreased MS flares during pregnancy?

A

Estriol (E3)

Most acitve during 3rd trimester

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16
Q

How does seizure frequency change during pregnancy?

Post-partum period?

A
  • Stays the same in pregnancy
  • Increases post-partum
17
Q

Which agents are used for abortive migraine management during pregnancy?

A
  • 1st line
    • Non-pharmacologic (cold compress)
    • Acetaminophin
  • 2nd line
    • NSAID - 1st and 2nd trimester only!!
    • Metoclopramide
  • 3rd line
    • Sumatriptan (1st line when not pregnant!)
  • DO NOT USE BARBITUATES, ERGOT, DHE
18
Q

What agents are used for prophylactic migraine treatment in pregnancy?

A

Usually not indicated during pregnacy - migraine frequencey decreases due to steadily inreasing estogen

If anything, use:

  • 1st line: Mg
  • 2nd line: Metoprolol, propranolol
    • Stop a few days before delivery
  • 3rd line: verapamil, TCAs, SSRI, SNRI
  • DO NOT GIVE VALPROIC ACID OR TOPIRAMATE
19
Q

How does estrogen (E2) influence epilepsy?

A

Estrogen (E2) lowers the seizure threshold

  • Potentiates Glutamate
    • -> Excitation
  • Inhibits GABA
    • -> Decreased inhibiton
20
Q

Which anti-seizure drug carries the highest risk of major congenital malformation?

A

Valproic acid

Also associated with lower IQ, increased risk of Autism

Better option = Lamotrigine

21
Q

Which medication for MS takes up to 2 years to wash out and is FDA pregnancy class X?

A

Teriflunamide

  • Persists in sperm too!

Neuroscience Module (11 decks)

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