Sex differences in seizure types and symptoms

Abstract

Background Despite the increasing interest in sex differences in disease manifestations and responses to treatment, very few data are available on sex differences in seizure types and semiology. The Epilepsy Phenome/Genome Project (EPGP) is a large-scale, multi-institutional, collaborative study that aims to create a comprehensive repository of detailed clinical information and DNA samples from a large cohort of people with epilepsy. We used this well-characterized cohort to explore differences in seizure types as well as focal seizure symptoms between males and females. Methods We reviewed the EPGP database and identified individuals with generalized epilepsy of unknown etiology (GE) (n=760; female 446, male 314), non-acquired focal epilepsy (NAFE) (n=476; female 245, male 231), or both (n=64; female 33, male 31). Demographic data along with characterization of seizure type and focal seizure semiologies were examined. Results In GE, males reported atonic seizures more frequently than females (6.5% vs. 1.7%; p<0.001). No differences were observed in other generalized seizure types. In NAFE, no sex differences were seen for seizure types with or without alteration of consciousness or progression to secondary generalization. Autonomic (16.4% vs. 26.6%; p=0.005), psychic (26.7% vs. 40.3%; p=0.001), and visual symptoms (10.3% vs. 19.9%; p=0.002) were more frequently reported in females than males. Specifically, of psychic symptoms, more females than males endorsed déjà vu (p=0.001), but not forced thoughts, derealization/depersonalization, jamais vu, or fear. With corrections for multiple comparisons, there were no significant differences in aphasic, motor, somatosensory, gustatory, olfactory, auditory, vertiginous, or ictal headache symptoms between sexes. Conclusions Significant differences between the sexes were observed in the reporting of atonic seizures, which was more common in males with GE, and for autonomic, visual, and psychic symptoms associated with NAFE, which were more common in females.

Sex differences among epileptic patients: a comparison of epilepsy and its impacts on demographic features, clinical characteristics, and management patterns in a tertiary care hospital in Egypt

“…The higher reporting of precipitating factors by our female patients may be related to their having an additional factor related to hormonal changes during menstruation causing changes in seizure frequency in association with menstrual cycles [28]. It is also plausible that differences in both brain-derived and systemically derived estrogens between sexes may lead to differences in responses to the inciting event of the seizure [29].…”

“…While differences in symptom reporting based upon sex are due to psychological, biological, or sociological factors remain unclear, the impact of one or all of these factors on epilepsy is points requiring further study [29].…”

Sex and Gender Differences in Central Nervous System-Related Disorders

“…Overall, no gender difference was found in localization-related epilepsy, but symptomatic localization-related epilepsies were found to be more frequent in men, while cryptogenic localization-related epilepsies were found to be more frequent in women [ 113 ]. Carlson et al [ 115 ] with the Epilepsy Phenome/Genome Project (EPGP) showed differences in several subjective ictal symptoms between males and females. The authors of these studies were not able to assess the neurobiological basis of such sex differences and could not completely rule out the possibility that the findings were biased by differences in symptom reporting and recognition; however, it is undeniable that they raise important questions about the differences that exist between sexes at the CS level.…”

Large Scale Gene Expression Meta-Analysis Reveals Tissue-Specific, Sex-Biased Gene Expression in Humans

“…Sex differences have also been identified in the age of onset of brain diseases such as schizophrenia, where males develop symptoms between 18 and 25 years of age whereas females develop symptoms between 25 and 35 years (Ochoa et al, 2012 ). Moreover, reported atonic seizures in epilepsy are more frequent in males compared to females (6.5 vs. 1.7%; Carlson et al, 2014 ). These sex differences in diseases may be the result of tissue-specific differential gene expression between males and females.…”