Catamenial epilepsy

Key points: Catamenial epilepsy is the exacerbation of seizures in relation to the menstrual cycle Factors contributing to catamenial seizures may include hormonal fluctuations and metabolic changes influencing antiepileptic drug (AED) levels Estrogen is mainly proconvulsant, progesterone is mainly anticonvulsantIn women who ovulate, catamenial seizures can occur perimenstrually (C1 pattern) or periovulatory (C2 pattern); in women who have anovulatory cycles, catamenial seizures can occur during the luteal phase (C3 pattern)Therapies for catamenial seizures include optimization of AEDs, non-hormonal therapies, hormonal therapies, and neurosteroids Introduction The term “catamenial” is derived from the Greek word “katamenios” meaning monthly. Catamenial epilepsy consists of patterns of seizure occurrence due to the variation in sex hormone secretion across the menstrual cycle. In ancient times the cyclical occurrence of epileptic seizures, like menstruation cycles, was attributed to the phases of the moon. In 1857, at a meeting of the Royal Medical and Chirurgical Society, Sir Charles Locock first described the relationship between epileptic seizures and the menstrual cycle. He described “a form of epilepsy to which special notice had not been drawn and which he had been in the habit of regarding as hysterical epilepsy … confined towomen … connected to menstruation … with paroxysms that only occurred at the menstrual period or except in the case of great mental excitement” [1]. In 1881, Gowers described the first series of menstruation-related seizures, in which he noted in 46 of 82 women, “the attacks were worse at the monthly periods” [1]. In recent years the pathophysiology, classification, and treatment of catamenial epilepsy have broadened – the subject of several comprehensive reviews [1].