Phenytoin pharmacokinetics in catamenial epilepsy

Shavit, Gabriel; Lerman, Pinchas; Korczyn, Amos D.; Kivity, Shmuel; Bechar, M; Gitter, S.

doi:10.1212/wnl.34.7.959

Cited by 85 publications

(52 citation statements)

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“…The premenstrual exacerbation of seizures has been attributed to the withdrawal of the antiseizure effects of progesterone (19). The premenstrual exacerbation of seizures may also be related to a decrease in serum antiepileptic drug (AED) levels (20,21), which generally de-crease in the days before menstruation (20,21). Hepatic mechanisms are implicated (20,21).…”

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confidence: 99%

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Three Patterns of Catamenial Epilepsy

1997

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Summary:Purpose: On the basis of the neuroactive properties of estradiol and progesterone and the menstrually related cyclic variations of their serum concentrations, we propose the existence of three hormonally based patterns of seizure exacerbation. Because previous reports both support and refute the concept of catamenial epilepsy, we test the hypothesis by charting seizures and menses and measuring midluteal serum progesterone levels to estimate the frequency of epileptic women with catamenial seizure exacerbation.Methods: One hundred eighty-four women with intractable complex partial seizures (CPS) charted their seizure occurrence and onset of menstruation on a calendar for one cycle during which they had a midluteal blood sample taken for serum progesterone determination on day 22. Levels >5 ng/ml were considered ovulatory. The cycle was divided into four phases with onset of menstruation being day 1: menstrual (M) = -3 to +3, follicular (F) = 4 to 9, ovulatory (0) = 10 to -13, and luteal (L) = -12 to -4. Average daily seizure frequency for each phase was calculated and compared among phases by repeatedmeasures analysis of variance (ANOVA) and the StudentNewman-Keul's test, separately for ovulatory and anovulatory cycles.Results We propose the existence of three hormonally based patterns of seizure exacerbation in epilepsy (1). Seizures do not occur randomly in most men and women with epilepsy (2). They tend to cluster in >50% of cases (2). Seizure clusters in turn may occur with temporal rhythmicity in a significant proportion of men (29%) and women (35%) with epilepsy (3). In women, seizures may cluster in relation to the menstrual cycle; such seizures are commonly termed catamenial epilepsy (4) and may be attributable to (a) the neuroactive properties of steroid hormones and (b) the cyclic variation in serum levels.Estradiol inhibits y-aminobutyric acid (GABA) and potentiates glutamatergic transmission (5). It increases neuronal metabolism and discharge rates (5,6). It pro-

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confidence: 99%

“…The premenstrual exacerbation of seizures may also be related to a decrease in serum antiepileptic drug (AED) levels (20,21), which generally de-crease in the days before menstruation (20,21). Hepatic mechanisms are implicated (20,21). Specifically, AEDs and gonadal steroids are metabolized by the same microsomal enzyme systems in hepatic cells.…”

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confidence: 99%

Three Patterns of Catamenial Epilepsy

1997

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“…5 There are also alterations in AED concentrations, as seen with phenytoin and lamotrigine, throughout the menstrual cycle. [6][7][8][9] In anovulatory cycles, there is an increase in seizures during the second half of the menstrual cycle. Seizure control may also change during perimenopause because of fluctuations in estrogen and progesterone.…”

Section: Menstrual Cycle and Fertilitymentioning

confidence: 99%

Managing Epilepsy in Women of Reproductive Age: A Review

et al. 2014

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“…Premenstrual exacerbation of seizures has been attributed to the withdrawal of the antiepileptic effects of progesterone (5334) and to declines in serum antiepileptic drug (AED) levels (55,56). Hepatic mechanisms have been implicated in the decline in AED levels (55,56).…”

Section: Hormonal Effects On Seizures: Clinical Data Physiologic Evidmentioning

confidence: 99%

“…Hepatic mechanisms have been implicated in the decline in AED levels (55,56). Midcycle exacerbations may be due to the preovulatory surge of estrogen unaccompanied by any rise in progesterone (53,54).…”

Section: Hormonal Effects On Seizures: Clinical Data Physiologic Evidmentioning

confidence: 99%

Hormonal Effects on Epilepsy in Women

Klein

Herzog

1998

Epilepsia

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This review focuses on basic scientific and clinical data concerning the effects of female gonadal and adrenal steroid hormones, as well as their related neuropeptides, on neuronal excitability and seizures, and on hormonal and hormonally derived treatments for epilepsy. HORMONAL EFFECTS ON NEURONAL EXCITABILITY AND SEIZURES: ANIMAL DATAGonadal and adrenal steroids act in the brain by longlatency receptor-mediated genomic and post-transcriptional mechanisms and by short-latency direct membrane-mediated actions (1,2). These steroids have wideranging influences on neuronal excitability and seizures in animal models (3). EstrogensPhysiologic and pharmacologic doses of estrogens lower seizure thresholds in most adult animal seizure models (4-8). However, ovariectomy in adult rats does not alter seizure threshold (5). Therefore, whereas estro-

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Phenytoin pharmacokinetics in catamenial epilepsy

Cited by 85 publications

References 0 publications

Three Patterns of Catamenial Epilepsy

Three Patterns of Catamenial Epilepsy

Managing Epilepsy in Women of Reproductive Age: A Review

Hormonal Effects on Epilepsy in Women

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