Browsing by Author "Nirmala, C"

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    Knowledge and practice profile of obstetricians regarding epilepsy in women in Kerala state, India
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2011) Bhat, M; Ramesha, KN; Nirmala, C; Sarma, PS; Thomas, SV
    Purpose: To assess the knowledge of obstetricians about concerns of women with epilepsy. Materials and Methods: We surveyed 97 obstetricians (teaching hospitals-43, private hospitals-32, and community health centers-21) using knowledge of women's issues and epilepsy (KOWIE) questionnaire II with additional questions. Results: The mean duration of practice of the surveyed obstetricians was 12.4 +/- 10.7 years and 94% were female doctors. Most of them were well informed about the teratogenic effects of AEDs (91%), need to continue antiepileptic drugs (AEDs) during pregnancy (95%), and the role of folic acid and vitamin K during pregnancy (95%). They agreed AEDs decrease the efficacy of oral contraception and it was safe for the woman to breast-feed the baby while on AEDs. Only 1/3(rd) of them knew that steroid hormones could alter seizure threshold or that AEDs could predispose to osteomalacia. Fewer doctors knew that WWE could have increased sexual dysfunction (29.9%) or infertility (26.8%). The knowledge did not vary according to years of practice or practice settings. Conclusions: Obstetricians were well informed about the fetal complications of antenatal AED exposure, but were under informed of other complications such as osteomalacia, sexual dysfunction, and infertility.
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    WOMEN WITH EPILEPSY AND INFERTILITY HAVE ABNORMAL REPRODUCTIVE HORMONAL PROFILE
    (EPILEPSIA, 2013) Thomas, SV; Thomas, AC; Thomas, SE; Mathai, A; Nirmala, C
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    Women with epilepsy and infertility have different reproductive hormone profile than others
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2013) Thomas, SV; Sarma, PS; Nirmala, C; Mathai, A; Thomas, SE; Thomas, AC
    Purpose: One-third of women with epilepsy (WWE) may experience infertility (failure to conceive after 12 months of regular unprotected intercourse). We aimed to compare the hormone profile of WWE and infertility (WWE-I) with that of WWE who had conceived earlier (WWE-F). Materials and Methods: In the Kerala Registry of Epilepsy and Pregnancy, we compared the clinical and hormone profile of 50 WWE-I and 40 age-matched WWE-F. Subjects were examined and blood samples were drawn in follicular phase (1-14 days) for 21 WWE-I and 18 WWE-F, in luteal phase (15-30 days) for 23 WWE-I and 15 WWE-F and beyond 30 days for 6 WWE-I and WWE-F who had irregular cycles. Results: The two groups were comparable regarding physical, epilepsy syndrome, duration of epilepsy, body mass index, and serum cholesterol levels. Menstrual periods were irregular for 6 WWE-I and 5 WWE-F. The WWE-I group (compared to the WWE-F group) had significantly (P < 0.01) higher levels of dehydroepiandrostenedione (2.0 +/- 1.7 ug/mL vs. 1.0 +/- 0.7 ug/mL) and luteinizing hormone-LH (26.4 +/- 37.3 mIU/mL vs. 9.9 +/- 14.5 mIU/mL) and lower levels of progesterone (5.2 +/- 9.2 ng/mL vs. 10.4 +/- 13.4 ng/mL). There was no significant difference in the levels of FT3, FT4, thyroid stimulating hormone, prolactin, follicle-stimulating hormone (FSH), progesterone, testosterone, or androstenedione levels. The WWE-I had 8.5 times higher risk (95% confidence interval 1.2-59.9) of abnormal LH/FSH ratio. WWE who were on antiepileptic drugs (AEDs) (compared to WWE who were not on AEDs) had higher risk of elevated LH/FSH ratio. Conclusion: The hormone profile of WWE-I is significantly different from that of WWE-F. These variations need to be interpreted with caution as a causal relationship to epilepsy or use of antiepileptic drugs need to be established through further studies.