The management of epilepsy should be patient centered, carefully balancing seizure elimination while minimizing adverse effects of antiseizure medications, with particular attention to sexual and reproductive health across the lifespan.
Folic acid supplementation is recommended to reduce the risk of congenital malformations in people with epilepsy of childbearing potential, but there is no consensus on the optimal dose.
Significant knowledge gaps remain regarding the risks of most new antiseizure medications, neurostimulation therapy, and ketogenic diets during pregnancy.
Data evaluating the effect of antiseizure medications on male patients with epilepsy, especially around conception, continue to be insufficient.
Both seizures and antiseizure medications can affect sexual and reproductive health in people with epilepsy.
Hormone fluctuations may affect seizure frequency, treatment decisions, and contraception in people with epilepsy.
A multidisciplinary approach is important for the treatment of people with epilepsy, particularly regarding sexual and reproductive health management.
This research article reviews the important connections between epilepsy treatment and sexual and reproductive health. People with epilepsy face unique challenges because both the seizures themselves and the medications used to control them can affect fertility, pregnancy outcomes, and sexual health. The article highlights that while folic acid is recommended to reduce birth defect risks for people with epilepsy who could become pregnant, doctors don't yet agree on the best dose to recommend. Additionally, there is very little reliable information about how newer seizure medications, brain stimulation devices, or special diets like the ketogenic diet might affect a developing baby during pregnancy. The article also points out a notable gap in medical research: very little is known about how epilepsy medications affect men's reproductive health or their role in conception. Hormonal changes — such as those that occur during the menstrual cycle, pregnancy, or menopause — can also change how often seizures happen and how well treatments work, adding another layer of complexity to care. Ongoing pregnancy registries that track outcomes across multiple medical centers are helping fill some of these knowledge gaps over time. This research suggests that epilepsy care should be highly personalized, taking into account each patient's reproductive plans, hormonal profile, and life circumstances. Because many people with epilepsy may need to take medication every day for their entire lives, the choice of medication requires careful thought about long-term effects on reproductive and sexual health. A team-based approach involving multiple types of healthcare providers is recommended to best support people with epilepsy throughout their reproductive years.
Bensalem-Owen M. (2025). Sexual and Reproductive Health in the Management of Epilepsy.. Continuum (Minneapolis, Minn.). https://doi.org/10.1212/cont.0000000000001531