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Richard H. Mattson, MD; Joyce A. Cramer; Philip D. Darney, MD; Frederick Naftolin, MD, DPhil

JAMA. 1986;256(2):238-240.

Abstract
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)

Author Affiliations
From the Departments of Neurology (Dr Mattson and Ms Cramer) and Obstetrics and Gynecology (Dr Naftolin), Yale University School of Medicine, New Haven, Conn; Epilepsy Center, Veterans Administration Medical Center, West Haven, Conn (Dr Mattson and Ms Cramer); and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco General Hospital (Dr Darney).

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

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