Hormone replacement therapy: will it affect seizure control and AED levels?

Area of Science:

• Neurology
• Epilepsy Research
• Reproductive Endocrinology

Background:

• Growing interest in reproductive changes in women with epilepsy (WWE), particularly during perimenopause, menopause, and postmenopause.
• Seizure frequency fluctuations during these reproductive transitions are increasingly recognized.
• Catamenial epilepsy patterns may predict hormonal influences on seizures.

Purpose of the Study:

• To review evidence on seizure frequency changes in WWE during perimenopause and postmenopause.
• To explore the impact of hormone replacement therapy (HRT) on seizure control in postmenopausal WWE.
• To reconcile discrepancies between clinical observations and laboratory findings regarding HRT and seizures.

Main Methods:

• Review of existing literature on seizure frequency in WWE during reproductive transitions.
• Analysis of questionnaire data and clinical trial results on HRT use in postmenopausal WWE.
• Examination of preclinical studies using rodent models to investigate hormonal effects on seizures.

Main Results:

• Seizure frequency can change during perimenopause (increase) and menopause (decrease) in WWE.
• HRT use in postmenopausal WWE is associated with adverse effects on seizure frequency, confirmed by clinical trials.
• Rodent models suggest estrogen and progesterone can be neuroprotective, contradicting some clinical findings.

Conclusions:

• A subset of WWE are sensitive to endogenous reproductive hormonal shifts.
• A discrepancy exists between laboratory and clinical findings regarding HRT's effect on seizures.
• Management strategies for HRT in postmenopausal WWE should consider specific estrogenic and progestogenic compounds to minimize seizure risk.