Three Patterns of Catamenial Epilepsy

Abstract

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-

Sex and Estrus Cycle Differences in the Modulatory Effects of Morphine on Seizure Susceptibility in Mice

“…It is known that sex hormones and their metabolites can modulate the GABA-receptor complex (GRC) (38). For example, estradiol is known to inhibit GABA and to promote kindling (39) and the occurrence of seizures in both experimental and clinical settings (40). In contrast, progesterone reduces neuronal metabolism, suppresses kindling and epileptiform discharges, and decreases the occurrence of seizures (2,(40)(41)(42).…”

Estrogen and brain-derived neurotrophic factor (BDNF) in hippocampus: Complexity of steroid hormone-growth factor interactions in the adult CNS

“…Thus, it has been suggested that women with epilepsy, who have an increase in seizures during the periovulatory period of their menstrual cycle (Catamenial Epilepsy, Type I; [147]) might do so because of the rapid rise in estradiol before ovulation. It is also possible, although less commonly discussed, that seizures that occur during the perimenstrual period could be due to an elevation of estradiol, because estradiol does increase during the luteal phase and this could elevate BDNF.…”

“…It is also possible, although less commonly discussed, that seizures that occur during the perimenstrual period could be due to an elevation of estradiol, because estradiol does increase during the luteal phase and this could elevate BDNF. Alternatively, and more widely accepted, is the view that waning progesterone at the time of menses leads to a disinhibition, and this lack of inhibition leads to increased seizure frequency [147].…”

High and Low Perceived Self‐Control of Epileptic Seizures

“…However, in addition to the finding that the HCs were less likely than the LCs to have complex partial seizures, it is also worth noting that there was a trend for greater proportion of women in the LC than HC group to report menstruation as a seizure precipitant ( 2 ‫ס‬ 2.91, df 1, p ‫ס‬ 0.088). Herzog et al (33), reviewing classifications of catamenial epilepsy, suggested that about a third of women with intractable complex partial seizures have seizures related to their menstrual cycle. It is possible that this biologic relationship between complex partial seizures and menstruation makes them seem less controllable.…”