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July 11, 1986, Vol 256, No. 2 >
ARTICLE | July 11, 1986

Use of Oral Contraceptives by Women With Epilepsy FREE

Richard H. Mattson, MD; Joyce A. Cramer; Philip D. Darney, MD; Frederick Naftolin, MD, DPhil
[+] Author Affiliations

Reprint requests to Epilepsy Center/127, Veterans Administration Medical Center, West Spring Street, West Haven, CT 06516 (Ms Cramer).


JAMA. 1986;256(2):238-240. doi:10.1001/jama.1986.03380020100031
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References

Oral contraceptives have not been associated with exacerbation of epilepsy despite warnings in package inserts. No clinical study has provided scientific evidence of worsening of seizures in epileptic women who use oral contraceptives, and improvement in seizure control has occurred in some cases. The main concern about use of oral contraceptives in this population is their effectiveness in preventing conception. Failure rates are higher in groups of women taking enzyme-inducing antiepileptic drugs. The degree of increased metabolism of estrogen and progestin components is highly variable and unpredictable among individuals. Use of higher doses increases protection against conception but also increases the risk of side effects, particularly in patients in whom no enzyme induction occurs. The strength of hormones in the pill should be selected individually when initiating use. Some women may require higher doses for full contraceptive effect.

(JAMA 1986;256:238-240)

REFERENCES

1 +
Wooley DE, Timiras PS:  Estrous and circadian periodicity and electroshock convulsions in rats . Am J Physiol 1962;;202:379-382.
2 +
Logothetis J, Harner R, Morrell F, et al:  The role of estrogens in catamenial exacerbation of epilepsy . Neurology 1959;;9:352-360.
3 +
Logothetis J, Harner R:  Electrocortical activation by estrogens . Arch Neurol 1960;;3:290-297.
4 +
Craig CR:  Anticonvulsant activity of steroids: Separability of anticonvulsant from hormonal effects . J Pharmacol Exp Ther 1966;;153:337-343.
5 +
Backstrom T, Zetterlund B, Blom S, et al:  Effects of IV progesterone infusions on the epileptic discharge frequency in women with partial epilepsy . Acta Neurol Scand 1984;;69:240-248.
6 +
Mattson RH, Cramer JA:  Epilepsy, sex hormones and antiepileptic drugs . Epilepsia 1985;; 26( (suppl 1) ):S40-S51.
7 +
Dana-Haeri J, Richens A:  Effects of norethisterone on seizures associated with menstruation . Epilepsia 1983;;24:377-381.
8 +
Mattson RH, Cramer JA, Caldwell BV, et al:  Treatment of seizures with medroxyprogesterone acetate: Preliminary report . Neurology 1984;; 34:1255-1258.
9 +
Kenyon IE:  Unplanned pregnancy in an epileptic . Br Med J 1972;;1:686-687.
10 +
Janz D, Schmidt D:  Antiepileptic drugs and failure of oral contraceptives . Lancet 1974;;1:1113.
11 +
Coulam CB, Annegers JF:  Do anticonvulsants reduce the efficacy of oral contraceptives ? Epilepsia 1979;;20:519-525.
12 +
Sonnen AE:  Sodium valproate and the contraceptive pill . Br J Clin Pract Symp Suppl 1983;; 27:31-36.
13 +
Orme ML:  The clinical pharmacology of oral contraceptive steroids . Br J Clin Pharmacol 1982;; 14:31-42.
14 +
Back DJ, Bates M, Bowden A, et al:  The interaction of phenobarbital and other anticonvulsants with oral contraceptive steroid therapy . Contraception 1980;;22:495-503.
15 +
Breckenridge AM, Back DJ, Orme M:  Interactions between oral contraceptives and other drugs . Pharmacol Ther 1979;;7:617-626.
16 +
Back DJ, Breckenridge AM, Crawford FE, et al:  The effect of oral contraceptive steroids and enzyme inducing drugs on sex hormone binding globulin capacity in women . Br J Clin Pharmacol 1980;;9:115.
17 +
Back DJ, Breckenridge AM, Crawford FE, et al:  Phenobarbitone interaction with oral contraceptive steroids in the rabbit and rat . Br J Pharmacol 1980;;69:441-452.
18 +
Back DJ, Breckenridge AM, MacIver M, et al:  The interaction of ethinyloestradiol with ascorbic acid in man . Br Med J 1981;;282:1516.
19 +
Daling JR, Weiss NS, Metch BJ, et al:  Primary tubal infertility in relation to the use of an intrauterine device . N Engl J Med 1985;;312:937-941.
20 +
Kay CR:  Progestins and arterial disease: evidence from the Royal College of General Practitioners study . Am J Obstet Gynecol 1982;;142:762-765.
21 +
Vessey MP, Lawless M, Yeates D:  Oral contraceptives and stroke: Findings in a large prospective study . Br Med J 1984;;289:530-531.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Wooley DE, Timiras PS:  Estrous and circadian periodicity and electroshock convulsions in rats . Am J Physiol 1962;;202:379-382.
2 +
Logothetis J, Harner R, Morrell F, et al:  The role of estrogens in catamenial exacerbation of epilepsy . Neurology 1959;;9:352-360.
3 +
Logothetis J, Harner R:  Electrocortical activation by estrogens . Arch Neurol 1960;;3:290-297.
4 +
Craig CR:  Anticonvulsant activity of steroids: Separability of anticonvulsant from hormonal effects . J Pharmacol Exp Ther 1966;;153:337-343.
5 +
Backstrom T, Zetterlund B, Blom S, et al:  Effects of IV progesterone infusions on the epileptic discharge frequency in women with partial epilepsy . Acta Neurol Scand 1984;;69:240-248.
6 +
Mattson RH, Cramer JA:  Epilepsy, sex hormones and antiepileptic drugs . Epilepsia 1985;; 26( (suppl 1) ):S40-S51.
7 +
Dana-Haeri J, Richens A:  Effects of norethisterone on seizures associated with menstruation . Epilepsia 1983;;24:377-381.
8 +
Mattson RH, Cramer JA, Caldwell BV, et al:  Treatment of seizures with medroxyprogesterone acetate: Preliminary report . Neurology 1984;; 34:1255-1258.
9 +
Kenyon IE:  Unplanned pregnancy in an epileptic . Br Med J 1972;;1:686-687.
10 +
Janz D, Schmidt D:  Antiepileptic drugs and failure of oral contraceptives . Lancet 1974;;1:1113.
11 +
Coulam CB, Annegers JF:  Do anticonvulsants reduce the efficacy of oral contraceptives ? Epilepsia 1979;;20:519-525.
12 +
Sonnen AE:  Sodium valproate and the contraceptive pill . Br J Clin Pract Symp Suppl 1983;; 27:31-36.
13 +
Orme ML:  The clinical pharmacology of oral contraceptive steroids . Br J Clin Pharmacol 1982;; 14:31-42.
14 +
Back DJ, Bates M, Bowden A, et al:  The interaction of phenobarbital and other anticonvulsants with oral contraceptive steroid therapy . Contraception 1980;;22:495-503.
15 +
Breckenridge AM, Back DJ, Orme M:  Interactions between oral contraceptives and other drugs . Pharmacol Ther 1979;;7:617-626.
16 +
Back DJ, Breckenridge AM, Crawford FE, et al:  The effect of oral contraceptive steroids and enzyme inducing drugs on sex hormone binding globulin capacity in women . Br J Clin Pharmacol 1980;;9:115.
17 +
Back DJ, Breckenridge AM, Crawford FE, et al:  Phenobarbitone interaction with oral contraceptive steroids in the rabbit and rat . Br J Pharmacol 1980;;69:441-452.
18 +
Back DJ, Breckenridge AM, MacIver M, et al:  The interaction of ethinyloestradiol with ascorbic acid in man . Br Med J 1981;;282:1516.
19 +
Daling JR, Weiss NS, Metch BJ, et al:  Primary tubal infertility in relation to the use of an intrauterine device . N Engl J Med 1985;;312:937-941.
20 +
Kay CR:  Progestins and arterial disease: evidence from the Royal College of General Practitioners study . Am J Obstet Gynecol 1982;;142:762-765.
21 +
Vessey MP, Lawless M, Yeates D:  Oral contraceptives and stroke: Findings in a large prospective study . Br Med J 1984;;289:530-531.

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