Epilepsy and the Menstrual Cycle
There is a type of epilepsy that is specific to women and may even affect the majority of women with epilepsy. Called catamenial epilepsy, it refers to changes in the frequency of seizures following fluctuations in hormone levels throughout the menstrual cycle.
You can help to determine the relationship between your seizures and your menstrual cycle by keeping a detailed diary of each. This can be more complicated than it seems at first. It is helpful to learn how to test when you are ovulating and to record that information as well as keeping track of the days during which you are menstruating. It is also important to record factors that may affect these patterns: missed pills, lack of sleep, stress, changes in physical activity and illness should be noted. Depending on the regularity of your menstrual cycle, this relationship may be easy or difficult to determine.
Seizure frequency can vary in different phases the menstrual cycle for several reasons. In some cases the reasons are not known or there may be no relationship at all. In other cases, the relationship is based on estrogen's excitatory effect and/or progesterone's inhibitory effect on the brain. As the levels of these and other sex hormones vary, the likelihood of having seizures changes. Different types of seizures are more likely to occur in different phases of the cycle. Sometimes, increased metabolism of antiepileptic drugs just before menstruation may cause decreased levels of the drugs in the blood allowing seizures to occur.
Establishing what, if any, relationship there is between seizures and menstruation may help you to determine more effective treatment.
Hormonal therapy, the use of add-on drugs or adjustments in dosage can you gain seizure control. Your GP or neurologist may be able to suggest options, or may refer you to a gynaecologist or endocrinologist to help establish appropriate treatment.
Many seizures do not occur randomly in the majority of men and women; they tend to cluster in over 50% of cases.
One such seizure cluster related to the menstrual cycle is called catamenial epilepsy. Women with epilepsy have varied seizures frequencies in relation to hormonal variations during the menstrual cycle. The study of the different phases of the menstrual cycle (preovulatory, follicular, ovulatory, luteal) has shown that estradiol (or estrogen) and progesterone may play a role in seizure expression and frequency.
There are 3 patterns of catamenial epilepsy:
- C1 = seizures around the start of your menstrual cycle
- C2 = seizures occurring at the end of your period for a couple of days
- C3 = seizures occurring during the days between your periods
Patterns can be seen by charting menses and seizures.
Some seizures types, such as
complex partial and
secondarily generalized, show all 3 patterns.
It is not guaranteed that you will find a definite pattern. There is still no universally accepted definition of catamenial epilepsy.
Possible hormone treatments used for catamenial epilepsy include:
- progestins/progesterones
- neuroactive steriods
- clomiphene
- LHRH agonists
- adrenal steriod- and CRH-based treatments.
Consult your health-care provider to get more detailed information on these drug therapies.
Mood disturbance with exacerbation (worsening) related to the menstrual cycle may be experienced by women with temporal lobe epilepsy. Women with epilepsy who suffer from catamenially-related anxiety, panic attacks and agitated depression often show a favorable response to treatment with progesterone or other agents. Severe pre-menstrual syndrome and cycle-related disorders of mood and thought can be effectively treated in many women with natural progesterone and other hormonal therapies.
