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Catamenial Epilepsy

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Neurology and Psychiatry of Women

Abstract

Catamenial epilepsy is a complex neuroendocrine disorder characterized by seizure clustering during different phases of the menstrual cycle (C1, perimenstrual; C2, periovulatory; C3, anovulatory cycles), with the majority of women experiencing seizure worsening perimenstrually. The working hypothesis for the ongoing basic and clinical research studies is that sex hormones influence neuronal excitability and their fluctuations during an ovarian-menstrual cycle drive the observed seizure clustering patterns (C1, progesterone decline; C2, estrogen surge; C3, low progesterone). At present, no personalized treatment is available for women with catamenial epilepsy whose seizures are frequently refractory to traditional antiepileptic medications. Common strategies involve increasing antiepileptic medication doses, addition of clobazam, or using contraceptive methods to suppress the hormonal cycling, but without solid clinical evidence. Progesterone lozenges used in the second part of the menstrual cycle is the only treatment with supporting evidence coming from the NIH Progesterone Treatment Trial, but only beneficial for a small subset of patients with C1 catamenial epilepsy.

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Authors and Affiliations

  1. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    P. Emanuela Voinescu

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  1. P. Emanuela Voinescu
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Correspondence to P. Emanuela Voinescu .

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  1. Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA

    Mary Angela O’Neal

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Voinescu, P.E. (2019). Catamenial Epilepsy. In: O’Neal, M. (eds) Neurology and Psychiatry of Women. Springer, Cham. https://doi.org/10.1007/978-3-030-04245-5_9

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  • DOI: https://doi.org/10.1007/978-3-030-04245-5_9

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  • Online ISBN: 978-3-030-04245-5

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