Psychology / Psychotherapy: 85b - Neurological Diseases in Women

Psychotherapy: 85b - Neurological Diseases in Women

Psychology21 CardsCreated 7 months ago

This flashcard set explains how fluctuations in sex hormones—particularly estrogen and progesterone—affect seizure frequency in epilepsy, trigger menstrually related migraines, and influence immune activity in multiple sclerosis (MS). It highlights the role of estrogen in inflammatory responses and the protective shift seen during pregnancy.

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

More estrogen + less progesterone -> more seizures

(Increased estrogen:progesterone ratio)

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Key Terms

Term

Definition

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

More estrogen + less progesterone -> more seizures

(Increased estrogen:progesterone ...

An abrupt drop in estorgen levels may trigger…

Epileptic seizures
MS flares
Menstrually related migraines

Menstrually related migraines

Rapid withdrawal of estrogen may trigger migraine
May happen just before menstrual perio...

How do sex hormones influence the course of MS?

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

Note: ...

How does progesterone influence epilepsy?

Progesterone increases seizure threshold

Potentiates GABA
-> Increased general inhibition

What happens to migraine in pregnancy?

Migraines unusual in 1st and 2nd trimester
- Estrogen slowly increasing
Increase during 3rd trimes...

Valproic acid should be avoided in which population

Women of childbearing age

Find soemthing else to treat migraine or epilepsy in anyone w...

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

More likely

(More estrogen + less progesterone -> more seizures)

What happens to migraine frequency during menopause?

More migraines during menopause as estrogen levels rapidly fall
Much lower frequency of migraines after menopause

What agents are used for prophylactic migraine treatment in pregnancy?

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

How does estrogen (E2) influence epilepsy?

Estrogen (E2) lowers the seizure threshold

Potentiates Glutamate
- -> Excitation
Inhi...

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Psychotherapy: 85b - Neurological Diseases in Women

Term	Definition
Which hormonal fluctuations are likely to affect seizure frequency in women with epilepsy?	More estrogen + less progesterone -> more seizures (Increased estrogen:progesterone ratio)
An abrupt drop in estorgen levels may trigger… Epileptic seizures MS flares Menstrually related migraines	Menstrually related migraines Rapid withdrawal of estrogen may trigger migraine May happen just before menstrual period, postpartum, or perimenopause
How do sex hormones influence the course of MS?	Estrogen (E2) -> Th1 phenotype -> Inflammatory -> MS predisposition Note: E3 estrogen released in pregnancy leads to Th2 phenotype, MS remission
How does progesterone influence epilepsy?	Progesterone increases seizure threshold Potentiates GABA -> Increased general inhibition
What happens to migraine in pregnancy?	Migraines unusual in 1st and 2nd trimester Estrogen slowly increasing Increase during 3rd trimester, postpartum Rapid withdrawal of estrogen
Valproic acid should be avoided in which population	Women of childbearing age Find soemthing else to treat migraine or epilepsy in anyone who might have a child!!
Which AED is most affected by changes in drug metabolism during pregnancy?	Lamotrigine Glucuronidation is facilitated by estrogen -> Faster drug metabolism during pregnancy
Rapid withdrawal of which hormone is might trigger a migraine in a suceptible individual?	Estrogen
If a patient with MS needs a disease-modifying agent during pregnancy, which one should you use?	Glatimer acetate BUT, avoid DMAs in pregnancy if possible; MS flares are liekly to decrease due to increased E3 estrogen
If a patient is having higher estrogen and lower progesterone, are they more or less likely to have seizures?	More likely (More estrogen + less progesterone -> more seizures) Estrogen (E2) -> more seizures Progesterone -> fewer seizures
How does pregnancy affect MS?	Women with MS are likely to remit during pregnancy E3 estrogen released in pregnancy -> Th2 phenotype (less inflammatory, increased immune tolerance) Fewer MS flares
What is the best mode of contraception for a young woman with migrain with aura?	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
What happens to migraine frequency during menopause?	More migraines during menopause as estrogen levels rapidly fall Much lower frequency of migraines after menopause Estrogen is lower, but at a steady state
Many AEDs are enzyme inducers - what are the implications for patients taking oral contraceptive pills?	Less bioavailability of OCPs Notably, OCPs also decrease bioavailability of lamotrigine Recommend IUD, depo-provera, or condoms
Which hormone is associated with decreased MS flares during pregnancy?	Estriol (E3) Most acitve during 3rd trimester
How does seizure frequency change during pregnancy? Post-partum period?	Stays the same in pregnancy Increases post-partum
Which agents are used for abortive migraine management during pregnancy?	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
What agents are used for prophylactic migraine treatment in pregnancy?	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
How does estrogen (E2) influence epilepsy?	Estrogen (E2) lowers the seizure threshold Potentiates Glutamate -> Excitation Inhibits GABA -> Decreased inhibiton
Which anti-seizure drug carries the highest risk of major congenital malformation?	Valproic acid Also associated with lower IQ, increased risk of Autism Better option = Lamotrigine
Which medication for MS takes up to 2 years to wash out and is FDA pregnancy class X?	Teriflunamide Persists in sperm too!

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Psychotherapy: 85b - Neurological Diseases in Women

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

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