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Subbulakshmi was married two years ago. She is an epileptic and has been avoiding a pregnancy because she and her husband are worried that the baby might be affected by the medicines she is taking. They need not worry. With good preconceptional counselling and optimal obstetric care, she can have a normal pregnancy and baby. She can also safely breast feed her baby.

There are 5.5 to 7.8 million persons with epilepsy in India. To put it in perspective, this is about 1/8th of the world population! Unfortunately, the statistics in India are not accurate due to the stigma still associated with this disorder. Both in the urban and rural population, people still try to conceal the disease. Girls and women particularly delay seeking professional help.

As late as 1976, persons with epilepsy were denied the fundamental right of marriage and procreation by prejudiced legislation enacted in India. It is due to the selfless efforts of Dr. Mani, Dr. B. Ramamurthi and Dr. G. Arjundas, leading physicians of Chennai, and the Indian Epilepsy Association, that a public interest litigation was filed in the Supreme Court. It is only since 1999 that patients with epilepsy can have a legally valid marriage.

The effects of epilepsy on men and women are the same and both get treated with anti-epileptic drugs. There are, however, several features peculiar to women with epilepsy which need exceptional attention, individual care and empathy. The public attitude towards a person with seizures is, even in the 21st Century, fraught with fear, superstition, discrimination and erroneous beliefs. This is exaggerated in the case of a girl/woman and is true both in the educated and less educated population. The failure to convince people that epilepsy is like any other illness such as hypertension, diabetes, or asthma leads to difficulty in finding a good life partner.

Even in the urban setting, women continue largely to conceal the fact of their having seizures prior to marriage, urged on and prompted by parents. To avoid problems later in the marriage, it is best to have an informal discussion with a doctor by both parties so that all doubts can be laid to rest. There are cases where a disclosure of epilepsy after the marriage ends up in the woman being sent back to her parents’ home, even if she were pregnant. Many times if a baby boy is born, custody is taken by the man’s family but girl babies are invariably left with the mother!

About a quarter of women have an increase in seizures just before the period. An increase in seizures also occurs during the middle of the cycle, just prior to ovulation. This has been attributed to hormonal imbalance and increase in stress due to premenstrual tension. The seizures can be controlled with an adjustment of the drug dosage.

The chances of having a normal, healthy child are excellent — greater than 90 per cent. Both the neurologist and the obstetrician need to be involved in reviewing the anti-epileptic drug that the woman is on and in deciding whether there is need for a change in medication prior to the beginning of a pregnancy. It is best to be on a single drug.

Though there is a slightly increased risk of certain abnormalities in the baby due to anti-epileptic drugs, these problems can be prevented by taking folic acid supplementation (5mg/day), particularly prior to conception and in the first three months. A good quality ultrasound in the fifth month can ensure that the foetus does not have a birth defect. There may be a need to increase the dose of the anti-epileptic drug in pregnancy.

Women on a single drug can safely breast feed their babies in consultation with their paediatrician.

All available birth control methods can be used by persons with epilepsy. Birth control pills and intra-uterine devices are safe and reliable contraception. It is important to know that some anti-epileptic drugs can make birth control pills less effective in preventing pregnancy. It is best to involve both the neurologist and the obstetrician in deciding on the best method of contraception.

GITA ARJUN

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