Transcranial Magnetic Stimulation Evidence of a Potential Role for Progesterone in the Modulation of Premenstrual Corticocortical Inhibition in a Woman with Catamenial Seizure Exacerbation

Herzog, Andrew G.; Friedman, Mark N.; Freund, Stefanie; Pascual‐Leone, Álvaro

doi:10.1006/ebeh.2001.0232

Cited by 27 publications

(15 citation statements)

References 15 publications

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“…Seizures decrease in the mid-luteal phase when serum progesterone levels are high and increase premenstrually when progesterone levels fall and there is a decrease in the serum progesterone-to-estrogen ratio (Backstrom, 1976; Bonucelli et al, 1989; Herzog et al, 2001). Changes in progesterone levels have been directly correlated with catamenial seizures (Tuveri et al, 2008; El-Khayat et al, 2008).…”

Section: Neuroendocrine Mechanisms Of Catamenial Epilepsymentioning

confidence: 99%

Neurosteroids and their role in sex-specific epilepsies

Reddy

2014

Neurobiology of Disease

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Neurosteroids are involved in sex-specific epilepsies. Allopregnanolone and related endogenous neurosteroids in the brain control excessive neuronal excitability and seizure susceptibility. Neurosteroids activate GABA-A receptors, especially extrasynaptic αβδ-GABA-A receptor subtypes that mediate tonic inhibition and thus dampen network excitability. Our studies over the past decade have shown that neurosteroids are broad-spectrum anticonvulsants and confer seizure protection in various animal models. Neurosteroids also exert antiepileptogenic effects. There is emerging evidence on a critical role for neurosteroids in the pathophysiology of the sex-specific forms of epilepsies such as catamenial epilepsy, a menstrual cycle-related seizure disorder in women. Catamenial epilepsy is a neuroendocrine condition in which seizures are clustered around specific points in the menstrual cycle, most often around the perimenstrual or periovulatory period. Apart from ovarian hormones, fluctuations in neurosteroid levels could play a critical role in this gender-specific epilepsy. Neurosteroids also regulate the plasticity of synaptic and extrasynaptic GABA-A receptors in the hippocampus and other regions involved in epilepsy pathology. Based on these studies, we proposed a neurosteroid replacement therapy for catamenial epilepsy. Thus, neurosteroids are novel drug targets for pharmacotherapy of epilepsy.

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Section: Neuroendocrine Mechanisms Of Catamenial Epilepsymentioning

confidence: 99%

Neurosteroids and their role in sex-specific epilepsies

Reddy

2014

Neurobiology of Disease

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“…[627] In the mid-luteal phase, while progesterone level is increased, the number of the seizures decreases and when the progesterone level is decreased, the number of the seizures increases. [2829] In patients with catamenial epilepsy, serum level of progesterone in the mid-luteal phase is significantly lower than in the control group. [6] There has already been no particular treatment for catamenial epilepsy and common anti-epileptic drugs are mostly used in controlling the catamenial epilepsy in women; however, given that the seizures are most often resistant to these drugs, more than one type of anti-epileptic drugs is used in these women, dependent on the seizure type.…”

Section: Discussionmentioning

confidence: 99%

Progesterone therapy in women with intractable catamenial epilepsy

Najafi¹,

Sadeghi²,

Mehvari³

et al. 2013

Adv Biomed Res

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Background:Catamenial epilepsy is a kind of epilepsy, known in this name, when the periodicity of the exacerbation of the seizure is in association with menstural cycle. The present study examined the progesterone effectiveness as a complementary treatment in women with intractable catamenial epilepsy.Materials and Methods:The present study was conducted as a double-blind randomized controlled trial on 38 women with intractable catamenial epilepsy. Patients were assessed in two groups: The case group received in addition to AEDs, two (Mejestrol) 40 mg progesterone tablets in the second half of the cycle from 15th to 25th day. And the control group received in addition to AEDs, two placebo tablets daily. Age, BMI, epilepsy duration, types of the drugs used, progesterone level, and the number of the seizures in 3 months before and after the study were compared.Results:Based on the results of which there was no statistically significant difference in regard to age, BMI, epilepsy duration, types of the drugs used, progesterone level between the case and the control groups (P-value > 0.05). The number of the seizures after treatment has significantly decreased compared to before-treatment state. The degree of decreasing in the case group receiving the progesterone was higher than in the control group receiving the placebo. The difference, thus, is significant, based on statistical tests (P-value = 0.024).Conclusion:Based on the findings of this study using progesterone in women with intractable catamenial epilepsy has a significant effect on the degree of decreasing in the number of the seizures.

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“…Natural variations in progesterone levels occur during the menstrual cycle which can influence catamenial seizure susceptibility (Tuveri et al, 2008; El-Khayat et al, 2008). In this light, seizures tend to increase when there is a decrease in the serum progesterone-to-estrogen ratio, during the premenstrual phase of the cycle, and seizures start to decrease during the mid-luteal phase while progesterone levels are high (Backstrom, 1976; Bonucelli et al, 1989; Herzog et al, 2001). Recent clinical trials have concluded that administration of progesterone is found to reduce seizures in women with epilepsy (Backstrom et al, 1984; Herzog, 2009).…”

Section: Role Of Neurosteroids In Sex-specific Catamenial Epilepsymentioning

confidence: 99%

Sex differences in the anticonvulsant activity of neurosteroids

Reddy

2016

J of Neuroscience Research

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Epilepsy is one of the leading causes of chronic neurological morbidity worldwide. Acquired epilepsy may result from a number of conditions such brain injury, anoxia, tumors, stroke, neurotoxicity, and prolonged seizures. Sex differences have been observed in many seizures types; however there are sex-specific seizure disorders that are much more prevalent in women. Despite some inconsistencies, there is a substantial amount of data which indicates that sensitivity to seizure stimuli differs between the sexes. Men generally exhibit greater seizure susceptibility than women, while many women with epilepsy experience a cyclical occurrence of seizures that tend to center around the menstrual period, which has been termed catamenial epilepsy. Some epilepsy syndromes show gender differences with female predominance or male predominance. Steroid hormones, endogenous neurosteroids, and sexually dimorphic neural networks appear to play a key role in sex differences in seizure susceptibility. Neurosteroids such as allopregnanolone exhibit sex differences in their anticonvulsant activity. This article provides a brief overview of the evidence for sex differences in epilepsy and how sex differences influence the use of neurosteroids in epilepsy and epileptogenesis.

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Transcranial Magnetic Stimulation Evidence of a Potential Role for Progesterone in the Modulation of Premenstrual Corticocortical Inhibition in a Woman with Catamenial Seizure Exacerbation

Cited by 27 publications

References 15 publications

Neurosteroids and their role in sex-specific epilepsies

Neurosteroids and their role in sex-specific epilepsies

Progesterone therapy in women with intractable catamenial epilepsy

Sex differences in the anticonvulsant activity of neurosteroids

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