Dr Omar Danaoun
Menu
Loading...

Women's Hormones and Seizures - What you need to know

One second you are walking on the street, going about your day as you usually do and the next second, you are lying on the ground convulsing. You may experience uncontrollable muscle spasms, stop moving and you may pass out. What you just experienced what is called a seizure.

Epilepsy refers to a condition where a patient experiences recurring seizures due to surges of electrical activity in their brain. These seizures may present in many ways.

Many women have observed that seizures are often increased in the few days just before their menstrual cycle starts or in the middle of the cycle. This phenomenon is known as Catamenial epilepsy. The reason for this significant increase in seizures is the drastic change in hormonal levels during different phases of the menstrual cycle.

Scientific basis

The menstrual cycle is a series of natural changes in the structures of the uterus and ovaries driven by cyclic changes in female reproductive hormones. It begins with the first day of bleeding, your period, which is considered as day 1. The cycle ends just before the next menstrual period, and it normally range from about 24 to 38 days

This cycle is regulated by hormones. Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH), which are produced by the pituitary gland, promote ovulation and stimulate the ovaries to produce estrogen and progesterone. Estrogen and progesterone stimulate the uterus and breasts to prepare for possible fertilization.

Estrogens may interact with antiseizure medications and may make them less functional. These drastic and rapid changes in hormone levels lead to Catamenial epilepsy, which affects a considerable proportion of women of reproductive age, especially among those who suffer from refractory epilepsy.

Diagnosis

The best tool for diagnosis of Catamenial epilepsy is maintaining a handy seizure diary with the seizures during the month and the relationship to the menstrual cycle. If you want to be really handy, you can do temperature measurement to prove ovulation because ovulatory and regular cycles are different from anovulatory cycle when there will be no ovum formed and you might miss a period, or it may be delayed that month.

Considering regular menstrual cycles, there are three variants based on when the seizure happens:

  • C1: When the seizure happens around the menstrual cycle
  • C2: When the seizures happen around the middle of the cycle or ovulation
  • C3: When the seizures happen in the later third of the period of called Luteal phase

Some women have both ovulatory and anovulatory cycles and therefore analysis of multiple cycles is required to arrive at a proper conclusion.

A new study showed that epilepsy and seizure have interesting pattern of fluctuations, some on a day and night pattern, weekly pattern, biweekly and triweekly and event monthly and were called ultradian, circadian, and multidien peaks. Interestingly, these patterns were seen in women and MEN.

Treatment of Catamenial Epilepsy

There are multiple treatment options:

  1. Increase the antiseizure medications to avoid fluctuation in levels
  2. Hormonal therapy with Estrogen-Progesterone combined pills to avoid fluctuation if pregnancy is not desired. Progesterone works best for C1 pattern and irregular cycles.
  3. Prevention by taking Benzodiazepines during the days where the seizures happen the most, we can give Clobazam 20-30 mg daily in the high risk 5 days based on the period, sometimes we give 3 days before and 2 days during or longer based on the seizure frequency and this showed good results in clinical trials.
  4. Acetazolamide can be beneficial in certain cases but data is limited regarding this drug.
  5. Neurosteroids such as Ganaxolone, which are fairly newer treatment options (still being studied)

References

 

Ask a Question

Ask anything about "Catamenial Epilepsy"