Epilepsy catamenial

For catamenial epilepsy (seizures just before or during menses) or seizures that occur at the time of ovulation, conventional AEDs should be tried first, but hormonal therapy (progestational agents) may also be effective. Intermittent acetazolamide has also been used. 

A low dosage of progestin ( mini-pill ) is used, in the form of medroxyprogesterone acetate, which is active at a very low dose. The mini-pill does not inhibit ovulation, but rather interferes with the endometrium and the cervical mucus. The use of this pill prevents most of the side effects of oral contraception, specifically nausea, water retention, and in some cases thrombophlebitis. However, a lower success rate and other frequent side effects have reduced the widespread acceptance of this preparation. Nevertheless, the mini-pill has a role to play in certain specific situations. For example, in an uncommon form of epilepsy called catamenial epilepsy, female patients will experience seizures at particular times during their menstrual cycle, reflecting the fact that seizure focus is stimulated by estrogens but inhibited by progestins. In such women, the mini-pill may afford not only birth control but also improved seizure control. 

In cases where fits are liable to occur at a particular time, e.g. the menstrual period, dosage should be adjusted to achieve maximal drug effect at that time or drug treatment can be confined to this time. For example, in catamenial epilepsy, clobazam can be useful given only at period time. 

Shavit G, Lerman P, Konczyn AD, et al. 1984. Pheny-toin pharmacokinetics in catamenial epilepsy. Neurology 34 959-961. 

Little is known regarding the effect of menopause on epilepsy. The perimenopausal period may be associated with worsening of seizures, possibly owing to fluctuations in sex hormones. At menopause, seizures actually may improve, particularly in women who previously presented with a catamenial pattern. The effect of hormone-replacement therapy on seizure control is still unclear, but clinicians should monitor for seizure exacerbation in women receiving supplemental estrogen. 

In 1857, Edward Sieveking presented 52 cases of human epilepsy to the Royal Medical and Chirurgical Society, now the Royal Society of Medicine, in London, and the chairman of the proceedings Sir Charles Locock commented that he had successfully treated women with hysterical epilepsy, in the majority of cases with menstrual, catamenial or uterine epilepsy, with potassium bromide. He had previously reasoned that on the basis of an earlier German report where 10 grains (about 0.7 g) resulted in impotence and ana-phrodisiac effects, and as masturbation was thought to be one of the causes of... 

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