Catamenial epilepsy refers to the temporal correlation of seizure exacerbations with the menstrual cycle. Changes in the serum estradiol and progesterone are implicated in this phenomenon, which makes management of epilepsy in women more challenging. This is a case of a 24-year-old nulligravid who was referred to a reproductive medicine specialist due to refractory focal seizures despite antiepileptic pharmacotherapy. EEG confirmed neurologic dysfunction but clinical history, physical examination, cranial CT and MRI ruled out structural, vascular, traumatic, and infectious causes of seizure. Adjunctive hormonal treatment was given, which improved patient symptoms. This report aims to discuss catamenial epilepsy as to its pathophysiology, diagnosis, and management. Better understanding of this disease entity will help address treatment difficulties in epilepsy in female patients and the associated management issues.
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