Catamenial Epilepsy

A number of women today are being affected by epileptic seizures. Almost half the numbers of women of childbearing age who are suffering from epilepsy have stated about an increase in seizures during their menstrual cycle. A seizure which happens mostly during a specific time during the menstrual cycle has been termed as catamenial epilepsy.

Catamenial epilepsy a kind of epilepsy is a unceasing neurological state typified by repeated seizures. Catamenial epilepsy is seen among the women who generally experiences seizures mostly during their menstrual cycle. Women suffering from catamenial epilepsy are abnormally responsive to endogenous hormonal transformations. The increase in seizures in these epileptic conditions shows significant positive connection to serum estrogen levels as well as ratios.

These seizures may occur during

  • Immediately before or at the starting of menses (1st day)
  • During ovulation (middle of the cycle)
  • Second half of the cycle for those with irregular cycles

Some women experience seizures more commonly just ahead of menstruation or during the initial days of the menstruation cycle or mid-cycle through ovulation period. The exact reasons causing catamenial epilepsy have not been understood clearly until now. Some of the assumed reasons may be the unequal balance between two sex hormones, estrogen and progesterone, or may be the female body is not be producing sufficient progesterone throughout the second half of the cycle. It may also happen that just ahead of the menstruation cycle the quantity of antiepileptic drug (AED) flowing in the patient’s veins may get reduced causing epileptic seizures.

The increase of catamenial seizures can be due to the hormonal imbalance in estrogen as well as progesterone. Estrogens assist in the occurrence of seizures, while progesterone guards the body against seizures. At the time of the menstruation, serum levels of estradiol and progesterone changes. Hence in a menstruating woman, the flow of estrogen during ovulation may be related with augmented seizure tendency; while the decrease in progesterone may cause seizures just before or during menstrual cycle.

To rationally treat catamenial seizures endocrine treatment can be considered as a good option. As progesterone shows anticonvulsant effects while estrogen shows proconvulsant effects, treating with progesterone/estrogen antagonists will show positive results with adjunctive treatments in suitable patients.

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