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Reproductive Endocrine Disorders
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Catamenial epilepsy refers to seizure exacerbation in relation to the menstrual cycle (14,15). Three patterns exist (16). One-quarter to three-quarters of women with epilepsy describe an increase in seizures during the few days prior to menstruation and the first 2 or 3 days of menstruation.A predilection for seizure exacerbation may also occur near the middle of the cycle, prior to ovulation between days 8 and 14. The onset of menstruation is the reference point for day 1.A more difficult pattern to discern is one in which seizures are frequent between day 8 of one cycle and day 2 of the next, relative to the interval between days 2 and 8.
Disorders of the nervous system
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Secondary (symptomatic) epilepsy is when an identified lesion or surgery interferes with brain tissue10,9. Catamenial epilepsy is epilepsy related to a change in seizure frequency across the menstrual cycle. For most women this means an increased number of seizures at the time of menstruation. Oestrogen can increase the excitability of neurons and progesterone inhibits11. This type of epilepsy improves in pregnancy.
Epilepsy and sex hormones
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
In most patients with epilepsy, seizures occur unpredictably and apparently haphazardly. This factor alone contributes significantly to the disability and inconvenience of seizures. However, it is not infrequent for seizures to occur in clusters or apparent cycles. In women, such cycles are often associated with menstruation: catamenial epilepsy. Locock, who introduced the first effective drug treatment for epilepsy, noted in 1857 that seizures were often associated with menstruation1. Gowers in 1885 found that in more than half of his female patients with epilepsy, seizures were worse premenstrually2. More recent studies have confirmed and extended these observations3-5. The timing of seizures corresponds to phases of the menstrual cycle when estrogen levels are relatively high or progesterone levels low6, 7. Seizures therefore occur predominantly during or a few days before menstruation. A mid-cycle peak in seizures may also occur, while anovulatory cycles may be associated with an increased frequency of seizures throughout the cycle4 or with the exception of the follicular phase8.
Cortical excitability in epilepsy and the impact of antiepileptic drugs: transcranial magnetic stimulation applications
Published in Expert Review of Neurotherapeutics, 2020
Catamenial epilepsy refers to seizure exacerbation in relation to particular times during the menstrual cycle, usually just before or during the onset of menstruation or at the time of ovulation. In some women, seizure frequency increases near the time of menstruation (perimenstrual seizure clustering) when steroid hormones’ levels are low and estradiol (E2) levels rise [48], i.e. seizures that are influenced by cyclical hormone changes. TMS studies showed an increase in ICF and a shorter CSP in females with catamenial epilepsy during the late luteal phase and menstruation compared to the follicular phase and regardless of whether cycles were ovulatory or anovulatory [49,50]. A reduction in GABA-mediated cortical inhibitory activity during the luteal phase and menstruation may be responsible for seizure exacerbation in women with premenstrual seizure exacerbation. The fall in serum progesterone has been suggested to be important because it would lead to a decline in progesterone’s metabolite that potentiates GABAA receptor-mediated inhibition. This is supported by the finding that administration of progesterone, a reproductive steroid with potent GABAergic metabolites (e.g. allopregnanolone), during the luteal phase restored cortical excitability to normal range [49].
Complete remission of cerebral endometriosis with dienogest: a case report
Published in Gynecological Endocrinology, 2018
Paolo Maniglio, Enzo Ricciardi, Federica Meli, Federica Tomao, Michele Peiretti, Donatella Caserta
Only three cases of cerebral endometriosis are reported in literature review with two of them being histologically confirmed. Regarding that, our case suggests that the immediate improvement of neurologic symptoms as soon as the treatment started may easily confirm the diagnosis [1]. Ichida et al. reported a case of a woman experiencing catamenial epilepsy that appeared with repetitive partial seizures on the first day of her menstrual cycle. The seizures were controlled by danazol and the causative brain hemosiderosis lesions were surgically removed and histologically confirmed as endometriosis lesions [4]. Thibodeau et al. described a rare case of cerebral endometriosis of a 20-year-old woman that presented with a 3-year history of intermittent focal headaches and a generalized seizure. Computerized tomography demonstrated a hypodense ring-enhancing cystic right parietal lobe lesion. At operation, a chocolate-colored cyst was excised which on histological examination proved to be endometriosis [5]. Finally, in 2011 Vilos et al. reported a case report of presumed cerebral endometriosis of a woman with abnormal uterine bleeding who developed catamenial neurologic signs and symptoms. Computed tomography scans and magnetic resonance images demonstrated a circumscribed lesion in the left centrum semiovale of the brain, suggesting the presence of a cerebral endometriosis localizations [6]. All neurologic symptoms resolved completely after the treatment with gonadotropin-releasing hormone agonist for 3 months and subsequent laparoscopic bilateral oophorectomy.
Non-pharmacological treatments for pediatric refractory epilepsies
Published in Expert Review of Neurotherapeutics, 2022
Eleonora Rotondo, Antonella Riva, Alessandro Graziosi, Noemi Pellegrino, Caterina Di Battista, Vincenzo Di Stefano, Pasquale Striano
Vitaminic supplementation as an adjunctive treatment in children with DRE has been studied in the literature; however, further studies are needed to assess the real role of vitamins in the treatment of epilepsy [76]. On the other hand, with regards to hormones, it seems that melatonin decreases seizure frequency; notwithstanding, it has not been demonstrated yet whether this is due to a better quality of sleep or a neuroprotective effect [82]. Whereas, adjunctive progesterone may be useful in women with catamenial epilepsy, a type of epilepsy closely linked to the cyclic hormonal changes of the menstrual cycle and, hence, causing cyclical relapses of seizures [76].