Phenytoin Levels in Catamenial Epilepsy

Kumar, Naveen; Behari, Madhuri; Gk, Ahuja; Jailkhani, B. L.

doi:10.1111/j.1528-1157.1988.tb04412.x

Cited by 45 publications

(26 citation statements)

References 20 publications

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“…Specifically, high levels of circulating oestrogen in the luteal phase could induce hepatic isoenzymes used for antiepileptic drug metabolism and thereby lower the levels of circulating antiepileptic drugs premenstrually, potentially permitting breakthrough seizures. 60 Rosciszewska and colleagues 61 reported that phenytoin levels on day 28 in women with catamenial seizures were significantly lower than those in women without cyclical exacerbations. Phenobarbital concentrations, however, did not change significantly.…”

Section: Endogenous Hormones and Catamenial Epilepsymentioning

confidence: 99%

Neuroendocrine considerations in the treatment of men and women with epilepsy

Harden

Pennell

2013

The Lancet Neurology

120

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Complex, multidirectional interactions between hormones, seizures, and the medications used to control them can present a challenge for clinicians treating patients with epilepsy. Many hormones act as neurosteroids, modulating brain excitability via direct binding sites. Thus, changes in endogenous or exogenous hormone levels can affect the occurrence of seizures directly as well as indirectly through pharmacokinetic effects that alter the concentrations of antiepileptic drugs. The underlying structural and physiological brain abnormalities of epilepsy and the metabolic activity of antiepileptic drugs can adversely affect hypothalamic and gonadal functioning. Knowledge of these complex interactions has increased and can now be incorporated in meaningful treatment approaches for men and women with epilepsy.

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Section: Endogenous Hormones and Catamenial Epilepsymentioning

confidence: 99%

Neuroendocrine considerations in the treatment of men and women with epilepsy

Harden

Pennell

2013

The Lancet Neurology

120

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“…Catamenial epilepsy, in many cases, is assumed to be an acquired disorder and currently there is no clear evidence of genetic components. A variety of mechanisms such as fluctuations in antiepileptic drug levels, changes in water and electrolyte balance, and physiological variation in ovarian hormone secretion have been proposed as causes for catamenial epilepsy (McQuarrie and Peeler, 1931; Ansell and Clarke, 1956; Shavit et al, 1984; Rosciszewska et al, 1986; Kumar et al, 1988; Narbone et al, 1990; Herzog, 1991; Herkes et al, 1993; Rodriguez-Macias, 1996; Harden et al, 1999; Tuveri et al, 2008). Overall, cyclical changes in the circulating levels of estrogens and progesterone are now widely accepted to play a central role in the development of this condition (Fig.…”

Section: Pathophysiology Of Catamenial Epilepsymentioning

confidence: 99%

The role of neurosteroids in the pathophysiology and treatment of catamenial epilepsy

Reddy¹

2009

Epilepsy Research

150

180

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SUMMARYCatamenial epilepsy is a multifaceted neuroendocrine condition in which seizures are clustered around specific points in the menstrual cycle, most often around perimenstrual or periovulatory period. Generally, a two-fold or greater increase in seizure frequency during a particular phase of the menstrual cycle could be considered as catamenial epilepsy. Based on this criteria, recent clinical studies indicate that catamenial epilepsy affects 31 -60% of the women with epilepsy. Three types of catamenial seizures (perimenstrual, periovulatory and inadequate luteal) have been identified. However, there is no specific drug available today for catamenial epilepsy, which has not been successfully treated with conventional antiepileptic drugs. Elucidation of the pathophysiology of catamenial epilepsy is a prerequisite to develop specific targeted approaches for treatment or prevention of the disorder. Cyclical changes in the circulating levels of estrogens and progesterone play a central role in the development of catamenial epilepsy. There is emerging evidence that endogenous neurosteroids with anticonvulsant or proconvulsant effects could play a critical role in catamenial epilepsy. It is thought that perimenstrual catamenial epilepsy is associated with the withdrawal of anticonvulsant neurosteroids. Progesterone and other hormonal agents have been shown in limited trials to be moderately effective in catamenial epilepsy, but may cause endocrine side effects. Synthetic neurosteroids, which enhance the tonic GABA-A receptor function, might provide an effective approach for the catamenial epilepsy therapy without producing hormonal side effects.

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“…20 Changing levels of estrogen and progesterone throughout the cycle may alter the metabolism of anticonvulsant drugs, via release of hepatic monooxygenase enzymes. 1,21 …”

Section: Examining Etiologic Factors In Menstrual Cycle Disease Exacementioning

confidence: 99%

Menstrual cycle-related exacerbation of disease

Pinkerton¹,

Guico-Pabia²,

Taylor³

2010

American Journal of Obstetrics and Gynecology

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Exacerbation of common medical and mental health disorders at specific phases of the menstrual cycle is a prevalent phenomenon. Although the precise cause is unclear, studies implicate complex interactions between the immune and neuroendocrine systems. The menstrual cycle also is a trigger for the onset of depressive disorders, including premenstrual dysphoric disorder, a disorder specific to the luteal phase of the menstrual cycle, and depression associated with the transition to menopause. This article discusses common mental health problems exacerbated by the menstrual cycle, with a particular focus on premenstrual dysphoric disorder and perimenopausal depression. Throughout the reproductive lifespan, routine screening and assessment for the presence of common psychiatric disorders are critical for accurate diagnosis and provision of effective treatment. Management options include referral or consultation with a primary care provider or psychiatrist; treatment options for premenstrual dysphoric disorder and perimenopausal depression include pharmacotherapy with antidepressant agents and/or psychotherapy. Hormones may be helpful.

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Phenytoin Levels in Catamenial Epilepsy

Cited by 45 publications

References 20 publications

Neuroendocrine considerations in the treatment of men and women with epilepsy

Neuroendocrine considerations in the treatment of men and women with epilepsy

The role of neurosteroids in the pathophysiology and treatment of catamenial epilepsy

Menstrual cycle-related exacerbation of disease

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