Three patterns of catamenial epilepsy

Area of Science:

• Neurology
• Endocrinology
• Epilepsy Research

Background:

• Estradiol and progesterone exhibit neuroactive properties.
• Cyclic variations in female hormone levels are linked to seizure exacerbation.
• Previous research on catamenial epilepsy (seizures linked to menstrual cycles) has yielded conflicting results.

Purpose of the Study:

• To test the hypothesis of hormonally based patterns of seizure exacerbation.
• To estimate the frequency of catamenial seizure exacerbation in women with epilepsy.
• To identify three distinct patterns of catamenial epilepsy based on hormonal fluctuations.

Main Methods:

• One hundred eighty-four women with intractable complex partial seizures (CPS) charted seizures and menses.
• Mid-luteal serum progesterone levels were measured to determine ovulation.
• Seizure frequency was analyzed across four cycle phases: menstrual, follicular, ovulatory, and luteal.

Main Results:

• In ovulatory cycles, seizure frequency was significantly higher during the menstrual and ovulatory phases.
• In anovulatory cycles, seizure frequency was significantly higher throughout the second half of the cycle.
• Approximately one-third of women exhibited at least a twofold increase in daily seizure frequency, supporting a proposed definition for catamenial epilepsy.

Conclusions:

• Charting seizures and menses, along with progesterone level determination, can establish three distinct patterns of catamenial epilepsy.
• Catamenial epilepsy affects approximately one-third of women with intractable complex partial seizures.
• The findings support a hormonal basis for seizure exacerbation in epilepsy related to the menstrual cycle.