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Menopausal Women with Epilepsy: Impact on Quality of Life —
Thursday, September 17, 2009 - 12 noon (EST)

Adele Viguera, MD

  • Associate Director of the Perinatal and Reproductive Psychiatry Program
  • Cleveland Clinic Neurological Institute

Despite the fact that more than one million women are expected to reach menopause each year, the relationship between menopause and epilepsy, as well as, treatment interventions for menopausal-related symptoms, have not been systematically investigated (Abbasi 1999, Harden 2002, 2007,Herzog 1999). While women with epilepsy (WWE) are likely to experience menopausal symptoms including hot flushes, night sweats, sleep disturbance, and mood symptoms which may substantially impact quality of life, there are no epidemiologic studies examining the prevalence or severity of these symptoms among WWE. With respect to treatment of typical menopausal symptoms, fewer women are receiving hormonal replacement therapy (HRT) given the recent findings from the Women's Health Initiative (WHI) of reported health risks including cardiovascular events and breast cancer, leaving many women symptomatic (Rossouw 2002, Kim 2005). Moreover, treatment with HRT may pose additional risks for WWE including an increase in seizure frequency and altered clearance of some antiepileptics (AEDs) (Abbasi 1999, Harden 2008, 2006). Given these treatment obstacles, it is remarkable that to date, there are no published studies on the efficacy of alternative treatments to HRT, such as serotonin reuptake inhibitors (SSRIs), for menopause-related symptoms in women with epilepsy.

Dr. Viguera is the Associate Director of the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital and Assistant Professor of Psychiatry at Harvard Medical School. She joined the Cleveland Clinic staff in October 2007, and will continue to lead research efforts in women's mental health.

Dr. Viguera completed her medical internship at the Massachusetts General Hospital before starting her psychiatry residency at McLean Hospital in Belmont, Massachusetts. She completed a clinical fellowship in Consultation-Liaison Psychiatry and a fellowship in Perinatal and Reproductive Psychiatry at MGH. Dr. Viguera has been the Associate Director of the Massachusetts General Hospital Perinatal and Reproductive Psychiatry Program since 1997. She has played an important role in the program's growth into a nationally recognized clinical and research center addressing a wide range of reproductive- associated psychiatric syndromes including premenstrual dysphoric disorder, antenatal mood disorders, postpartum depression, and peri and postmenopausal mood disturbance. Her leadership within the Program has been complemented by dedication to teaching and mentoring psychiatric residents, fellows, medical students, and junior faculty over the past ten years.

With respect to research, Dr. Viguera has had very successful track record securing support to study important research questions in reproductive psychiatry. Early in her academic career, she was the recipient of an NIMH K23 Career Development Award (K23 MH-11609), focused on The Course of Bipolar Disorder in Pregnancy and the Postpartum Period. In 2003, she also earned a Masters degree in Public Health in Quantitative Methods at the Harvard School of Public Health as part of her K23 grant. She has received additional awards from private foundations including two consecutive National Alliance for Research in Schizophrenia and Depression (NARSAD) Young Investigator research Awards for the study of Neonatal Outcome Following Exposure to Lithium . In 2004, she received a two-year Harvard Medical School Scholars in Medicine Fellowship Claflin Award for a project entitled, Screening for Antenatal Bipolar Disorder associated with Maternal Morbidity and Adverse Neonatal Outcome. The body of research laid the groundwork for an R01 award in 2005 from The National Institute of Mental Health for a multi-site collaborative study with Emory School of Medicine on Bipolar Disorder in Pregnancy: Predictors of Morbidity (Collaborative Grant: R01 MH 071762 [Viguera]; R01 MH 071531[Newport]). The study is currently in progress.

Dr Viguera's major research interests include: 1) longitudinal course and treatment of psychiatric illness during pregnancy and the postpartum period, 2) efficacy of antidepressant therapy for premenstrual dysphoric disorder, postpartum psychiatric illness, and perimenopausal mood disturbance, 3) perinatal and neurobehavioral sequelae of maternal psychiatric illness on child development, 4) psychotropics and lactation, and 5) efficacy of hormone therapy for the acute and prophylactic treatment of mood disturbance in women. With her family's recent move to Cleveland, Dr. Viguera will lead research efforts in women's mental health at the Cleveland Clinic, as well as, continue her collaboration Massachusetts General Hospital.

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