Epilepsy connected to menstrual cycles: Origin, identification, and management strategies
In the world of epilepsy, a particular subtype known as catamenial epilepsy affects around 40% of females with the condition. This form of epilepsy is characterised by seizures that intensify or become more frequent at certain points in the menstrual cycle.
Scientists believe that catamenial seizures occur due to changes in estrogen and progesterone levels that occur throughout the menstrual cycle. To better understand and manage this condition, it's crucial to keep a seizure diary, as recommended by Epilepsy Action, to record seizure occurrences and menstrual cycle phases.
Catamenial epilepsy is divided into three subtypes: Type 1, Type 2, and Type 3. Type 1 pattern involves worsened symptoms in the days before or during a period, while Type 2 pattern worsens around ovulation, which occurs approximately 10-16 days before a period for most individuals. Type 3 pattern, on the other hand, involves worsened symptoms in the second half of the menstrual cycle, known as the luteal phase.
One potential treatment for catamenial epilepsy is Clobazam (Onfi), but it belongs to a class of drugs with a high risk of misuse. Progesterone therapy is commonly used to counteract the seizure-provocative effects of estradiol. GnRH analogues can suppress the menstrual cycle altogether, reducing seizure clustering caused by cyclic hormone changes.
In cases of irregular cycles, treatments such as hormonal therapies like progesterone therapy, GnRH analogues, and continuous or cyclic hormonal contraceptives are used to stabilise hormonal fluctuations that influence seizure patterns. Continuous hormonal contraceptives, such as continuous combined pills or hormonal intrauterine devices like Mirena, may be recommended to induce hormonal stability and reduce seizure exacerbations.
Careful selection of anti-epileptic drugs (AEDs) is also important, as some AEDs interact with sex hormones, influencing hormone levels and seizure control. For example, enzyme-inducing AEDs like carbamazepine or oxcarbamazepine can lower sex steroid hormone concentrations, requiring dose adjustments in hormonal treatment.
While oral contraceptive pills do not appear to be beneficial for catamenial epilepsy, Hormonal Replacement Therapy (HRT) may have a positive impact on those going through menopause who have catamenial epilepsy, potentially reducing the risk of osteoporosis.
In addition, individuals with catamenial epilepsy who have irregular cycles may require treatments such as medroxyprogesterone injections or gonadotropin-releasing hormone analogs.
It's important to note that a 2021 review found no evidence that progesterone is more effective than a placebo for reducing seizure symptoms in catamenial epilepsy, but the evidence was of low quality.
Lastly, doctors maintain a seizure diary for at least 3 months to diagnose catamenial epilepsy. It's essential to record not only the menstrual cycle but also the duration of seizures in the diary, as this information can help in the diagnosis and treatment of catamenial epilepsy.
Women experiencing menstruation and those in menopause should be aware of the potential influence of hormonal changes on epilepsy, particularly catamenial epilepsy, which affects around 40% of female epilepsy patients. To help manage this condition, it's advised to keep a seizure diary, recording both seizure occurrences and menstrual cycle phases.
Treatment for catamenial epilepsy can include Clobazam (Onfi), progesterone therapy, GnRH analogues, continuous hormonal contraceptives, or medroxyprogesterone injections in cases of irregular cycles. However, it's important to note that some anti-epileptic drugs can interact with sex hormones, requiring careful selection and potential dose adjustments.
Moreover, the effectiveness of progesterone in reducing seizure symptoms in catamenial epilepsy is inconclusive, as a 2021 review found low-quality evidence supporting its use over a placebo.
Health and wellness practitioners, mental health professionals, and women's health specialists should collaborate to provide comprehensive care for women with catamenial epilepsy, ensuring diagnosis, treatment, and hormonal stability for better seizure control.
