- Sabiha Merchant, MD
Sabiha Merchant, MD
- Assistant Professor of Pediatrics and Neurology
- Weill Medical College of Cornell University
- Cynthia L Harden, MD
Cynthia L Harden, MD
- Professor of Neurology
- Hofstra North Shore - LIJ School of Medicine
INTRODUCTION AND DEFINITION
Catamenial epilepsy refers to a pattern of seizure clustering that is related to the menstrual cycle . It does not describe a seizure localization, seizure type, or epilepsy syndrome. Catamenial seizure clusters have been described with every seizure type and epilepsy syndrome.
The definition of catamenial epilepsy has varied among investigators. The most accepted criterion requires a doubling of a baseline seizure frequency during a specific phase of the menstrual cycle [1-4].
This topic will discuss specific aspects of seizures and epilepsy that relate to a catamenial pattern of seizure clustering. Other aspects of seizures and epilepsy are discussed separately. (See "Overview of the management of epilepsy in adults" and "Initial treatment of epilepsy in adults" and "Pathophysiology of seizures and epilepsy".)
The reported prevalence of catamenial clustering among women with epilepsy varies widely between 10 to 78 percent. This is mainly due to methodological differences among studies, which have used different patient populations, various criterion for diagnosis, and different recording mechanisms to link seizures with menstrual cycle phases [2,5]. In studies that used the above definition, and rigorous recording methods, approximately one-third of women with medically refractory epilepsy have a catamenial pattern of exacerbations [2,6,7].
While catamenial epilepsy necessarily affects women of child-bearing age, no other demographic features or other risk factors have been clearly defined for this phenomenon. One study found that a catamenial pattern was more common in the younger half (median age 40 years) of their population of 100 women of childbearing age with intractable focal epilepsy .
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- INTRODUCTION AND DEFINITION
- The normal menstrual cycle
- - Inadequate luteal phase cycles
- Hormonal influences on seizure occurrence
- Changes in antiseizure drug metabolism
- CLINICAL FEATURES
- Epilepsy syndrome
- Catamenial seizure patterns
- Intermittent benzodiazepines
- Modification of antiseizure drug regimen
- Hormonal therapy
- - Medroxyprogesterone acetate
- - Natural progesterone
- - Others
- SUMMARY AND RECOMMENDATIONS