Catamenial epilepsy: pathophysiology, diagnosis, and management

Area of Science:

• Neurology
• Endocrinology
• Women's Health

Background:

• Seizures in women with epilepsy are influenced by sex hormone fluctuations during the menstrual cycle.
• Estrogen can be proconvulsant, while progesterone exhibits anticonvulsant properties.
• Catamenial epilepsy affects about one-third of women with epilepsy, characterized by increased seizure frequency around menses.

Purpose of the Study:

• To review the understanding of catamenial epilepsy, including its patterns, diagnosis, and treatment.
• To highlight the need for further research into the pathophysiology and effective treatments for catamenial epilepsy.

Main Methods:

• Review of existing literature on catamenial epilepsy.
• Assessment of diagnostic methods including menstrual and seizure diaries.
• Evaluation of proposed therapeutic strategies.

Main Results:

• Three distinct patterns of catamenial epilepsy exist: perimenstrual, periovulatory, and luteal.
• Diagnosis relies on careful tracking of menstrual cycles and seizure frequency.
• Proposed treatments include acetazolamide, benzodiazepines, conventional antiepileptic drugs (AEDs), and hormonal therapy.

Conclusions:

• Evidence supporting current treatments for catamenial epilepsy is limited, often based on small or anecdotal reports.
• Larger multicenter trials are crucial for validating treatment efficacy.
• Further investigation into the underlying pathophysiology is required to develop optimal therapies for women with catamenial epilepsy.