Modification of therapy for exacerbation of seizures during menstruation

Complex, multidirectional interactions between hormones, seizures, and the medications used to control them can present a challenge for clinicians treating patients with epilepsy. Many hormones act as neurosteroids, modulating brain excitability via direct binding sites. Thus, changes in endogenous or exogenous hormone levels can affect the occurrence of seizures directly as well as indirectly through pharmacokinetic effects that alter the concentrations of antiepileptic drugs. The underlying structural and physiological brain abnormalities of epilepsy and the metabolic activity of antiepileptic drugs can adversely affect hypothalamic and gonadal functioning. Knowledge of these complex interactions has increased and can now be incorporated in meaningful treatment approaches for men and women with epilepsy.

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“…Effectiveness at doses of 250–500 mg daily administered from 3–7 days before menses has been reported. 65,66 …”

Section: Endogenous Hormones and Catamenial Epilepsymentioning

confidence: 99%

Neuroendocrine considerations in the treatment of men and women with epilepsy

Harden

Pennell

2013

The Lancet Neurology

115

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“…Few reports of the use of AZM in women with catamenial seizures are available. Poser (35) reported an anectodal improvement in seizures without adverse effects in women treated with 250 mg once or twice daily for 5–7 days before and during menses. Ansell et al (17) reported marked benefit in two subjects treated with 5 mg/kg/day for 3 days surrounding menses.…”

Section: Discussionmentioning

confidence: 99%

Acetazolamide in Women with Catamenial Epilepsy

Lim

Foldvary²,

Mascha

et al. 2001

Epilepsia

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Summary:Purpose: Catamenial epilepsy is a condition characterized by an increase in seizures during particular phases of the menstrual cycle. The incidence of catamenial epilepsy varies widely, partly because of a lack of a universally adopted definition. Specific treatment options for these patients are limited. The use of acetazolamide (AZ) has been based largely on anecdotal reports demonstrating efficacy in small or poorly characterized populations. The purpose of this study was to analyze retrospectively the efficacy, safety profile, and tolerability of AZ in women with catamenial epilepsy.Methods: Women with catamenial epilepsy identified from 1990 through 1999 were invited to participate in a retrospective telephone questionnaire addressing the relationship of seizures and the menstrual cycle and the use, efficacy, and adverse effects of AZ. Seizure outcome was classified as: seizure free (SF), significantly improved (SI), or not significantly improved (NSI). Responses to AZ were compared in women with different types of epilepsy and comparing continuous versus intermittent dosing using Fisher's exact tests.Results: Twenty women were identified who had received or were currently taking AZ. The drug was given continuously in 55% and intermittently in 45% of patients. A Ն50% decrease in the seizure frequency was reported by 40% of subjects. Response rates were similar in generalized and focal epilepsy and in temporal and extratemporal epilepsy. There was no significant difference in effectiveness comparing continuous with intermittent dosing. A loss of efficacy over 6-24 months was reported by 15% of women.Conclusions: Despite our small sample and retrospective design, AZ appears to demonstrate efficacy for catamenial epilepsy.

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“…Acetazolamide is used to treat catamenial epilepsy for 60 years (22), although it has never been evaluated in randomized studies. Doses of 250-500 mg per day have been effective when administered 3-7 days before the start of the cycle (22,23).…”

Section: Non-hormonal Therapymentioning

confidence: 99%

Catamenial Epilepsy - Update on Practical Management

Lukic¹

2018

AMM

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Catamenial epilepsy is a type of epilepsy that is characterized by aggravation and seizures clustering in a perimenstrual or periovulatory periods. Neuroactive properties of reproductive steroids and cyclic variations in their concentrations are important pathophysiological factors. Recent researches have demonstrated and confirmed the presence of at least three forms of catamenial aggravation of the attacks: perimenstrual and periovulatory in ovulation cycles and pattern throughout the whole luteal phase in anovulatory cycles. Rational models have identified that approximately one-third of women with epilepsy may have catamenial aggravation of the seizures. Open studies using cyclic natural progesterone as add-on therapy, medroxyprogesterone and gonadotropin-releasing hormone analogues have shown therapeutic benefits in certain forms of catamenial epilepsy. Therefore, it is important for the physician to consider catamenial epilepsy as a common type of epilepsy in women and recognize a particular pattern of this condition with the potential for good therapeutic response.

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Modification of therapy for exacerbation of seizures during menstruation

Cited by 32 publications

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Neuroendocrine considerations in the treatment of men and women with epilepsy

Neuroendocrine considerations in the treatment of men and women with epilepsy

Acetazolamide in Women with Catamenial Epilepsy

Catamenial Epilepsy - Update on Practical Management

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