Cleveland Clinic journal of medicine
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In persons with epilepsy, both seizures and antiepileptic drugs can disturb reproductive health. For example, seizures can alter the release of hypothalamic and pituitary hormones, while some antiepileptic drugs alter concentrations of sex steroid hormones. Women with epilepsy are at increased risk for polycystic ovary syndrome and disorders of the menstrual cycle. ⋯ The reasons for this reduction in fertility are likely to be both psychosocial and physiologic, and again, both epilepsy itself and antiepileptic drugs are implicated. Sexual dysfunction is common among patients with epilepsy and can have a somatic, psychological, or social basis. To provide the best care for patients with epilepsy, particularly women of reproductive age, clinicians must consider both the gender-based biology of epilepsy and the effects of antiepileptic drugs on reproductive health.
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The wide-ranging, multisystemic manifestations of sarcoidosis can make diagnosis and management difficult. Corticosteroid treatment is effective, but the optimal time to start, the dose, and the duration of treatment are controversial. We are just beginning to understand the genetic basis of sarcoidosis.
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Most women with epilepsy today can conceive and bear normal, healthy children, but their pregnancies present an increased risk for complications. Pregnancy can exacerbate seizure frequency in some women with epilepsy, and both maternal epilepsy and in utero exposure to antiepileptic drugs can increase the risk of adverse outcomes in children born to women with epilepsy. These outcomes include fetal loss and perinatal death, congenital malformations and anomalies, neonatal hemorrhage, low birth weight, developmental delay, and childhood epilepsy. After reviewing these risks, this article concludes with practical recommendations for reducing these risks and optimizing the management of pregnant women with epilepsy.