COMMENTARY

Estrogen, Progesterone, and Epilepsy: What's the Relationship?

Andrew N. Wilner, MD

Disclosures

January 15, 2015

Background

Approximately one third of women with intractable focal epilepsy have seizures related to their menstrual cycle, also known as "catamenial epilepsy."[1] Among their many biological effects, ovarian hormones may be neuroactive. Estrogen lowers seizure threshold while progesterone raises it, supporting a hormonal influence on seizure frequency that may underlie catamenial epilepsy.[1] Catamenial epilepsy can be diagnosed in women who experience at least twice their usual seizure frequency at a specific time around their menses.[1] Three patterns of catamenial epilepsy have been proposed, based on the timing of seizure exacerbation: (1) perimenstrual, (2) periovulatory, and (3) during the second half of an anovulatory cycle.[1]

Study Design and Baseline Characteristics

To evaluate the seizure course of patients with catamenial epilepsy during pregnancy, Cagnetti and colleagues[2] prospectively followed 274 women before and during pregnancy, of whom 59 had catamenial epilepsy and 215 had noncatamenial epilepsy.[2] For each participant, seizure frequency observed during pregnancy was compared with the 9-month period prior to pregnancy.

The two groups of participants had comparable baseline characteristics. Mean age at epilepsy onset was 16.7 years for the catamenial epilepsy group and 15.5 years for the noncatamenial epilepsy group. Mean age at pregnancy was 30.3 years for the catamenial epilepsy group and 30.7 years for the noncatamenial epilepsy group. With respect to epilepsy type, 45.8% of the catamenial epilepsy group had cryptogenic epilepsy vs 47.9% of the noncatamenial epilepsy group; 33.9% of the catamenial epilepsy group had idiopathic epilepsy vs 31.2% of the noncatamenial epilepsy group; and 20.3% of the catamenial epilepsy group had symptomatic epilepsy vs 20.9% of the noncatamenial epilepsy group. Focal seizures were the most common seizure type in both groups, occurring in 62.7% of participants in the catamenial epilepsy group and 53.5% of participants in the noncatamenial epilepsy group. Generalized seizures were less common and occurred in 33.9% of the catamenial epilepsy group and 41.9% of the noncatamenial epilepsy group. Undetermined seizure types occurred in 3.4% of the catamenial epilepsy group and 4.7% of the noncatamenial epilepsy group. Nearly all women in both groups were receiving antiepileptic drug (AED) treatment, with 96.6% of participants in the catamenial epilepsy group and 89.3% in the noncatamenial epilepsy group receiving at least one AED.

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