The literature regarding breastfeeding and effects of anti-seizure medication (ASM) exposure via breastmilk has evolved over the past two decades, with mounting evidence that supports breastfeeding for women with epilepsy (WWE) taking ASMs. In this chapter, we provide an overview of the current evidence that supports breastfeeding in infants of mothers taking ASM; safety profile of each ASM and reported adverse effects for various ASMs. Lastly, we review rates and patterns, as well as potential barriers to breastfeeding in WWE and potential intervention to improve breastfeeding practices in WWE.

Catamenial epilepsy is a pattern of seizure exacerbation from sensitivity to hormonal changes throughout the menstrual cycle. This hormonal sensitivity is common, occurring in approximately one third of women with epilepsy. There are three patterns of catamenial epilepsy, with the perimenstrual (C1) pattern occurring most frequently. The pathophysiology of catamenial epilepsy is complex, but studies suggest that it is primarily due to the fluctuations in the ratio of estrogen to progesterone throughout the menstrual cycle, with a worsening of seizures at times of increased estrogen-to-progesterone ratio. Therapies for catamenial seizures that have been described include hormonal therapies such as progesterone supplementation and cycle suppression. Non-hormonal therapies including pulse-dosed medications as well as optimization of anti-seizure medications at specific times in the menstrual cycle have been tried. Evidence for specific treatment of catamenial epilepsy, however, remains sparse and no highly effective treatment has been described. A few studies suggest that patients with hormone sensitive seizures may have specific responses in pregnancy, perimenopause and menopause, however further prospective studies are needed.