Hormones and seizures*
Nancy Foldvary-Schaefer, DO
Deparment of Neurology, The Cleveland Clinic Foundation, Cleveland, OH
Cynthia Harden, MD
Weill Cornell Medical College Comprehensive Epilepsy Center, New York, NY
Andrew Herzog, MD
Neuroendocrine Unit at Beth Israel Deaconess Medical Center and the Department of Neurology, Harvard Medical School, Boston, MA
Tommaso Falcone, MD
Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, OH
Correspondence: Nancy Foldvary-Schaefer, DO, Department of Neurology, Section of Epilepsy, The Cleveland Clinic Foundation, 9500 Euclid Avenue, S51, Cleveland, OH 44195; e-mail: email@example.com
*This article has been excerpted and adapted, with permission, from two previous review articles by these authors:
- Foldvary-Schaefer N, Falcone T. Catamenial epilepsy: pathophysiology, diagnosis, and management. Neurology 2003; 61(6 suppl 2):S2–S15.
- Harden CL. Menopause and bone density issues for women with epilepsy. Neurology 2003; 61(6 suppl 2):S16–S22.
Dr. Foldvary-Schaefer receives grants/research support from the National Institutes of Health, GlaxoSmithKline, UCB Pharma, Medtronic, Shire, and Solvay.
Dr. Harden receives grants/research support from Pfizer, GlaxoSmithKline, and Ivax; is a consultant for GlaxoSmithKline and Novartis; and has received honoraria from Novartis, GlaxoSmithKline, and Ortho-McNeil.
Drs. Herzog and Falcone have indicated they have nothing to disclose.
The opposing effects of estrogen (proconvulsant) and progesterone (anticonvulsant) on seizure threshold have been noted in animal and human studies. Levels of these hormones fluctuate throughout the menstrual cycle, and, in some women with epilepsy, these fluctuations may be related to the occurrence of seizures around the time of menses or an increase in seizures in relation to the menstrual cycle, also known as catamenial epilepsy. Variations in concentrations of antiepileptic drugs across the menstrual cycle may also contribute to increased seizure susceptibility. Diagnosis of catamenial epilepsy requires careful assessment of menstrual and seizure diaries and characterization of cycle duration and type. While there are several approaches to the treatment of catamenial epilepsy, each is based on small, unblinded studies or anecdotal reports. It is important for the physician to work closely with the patient to determine whether her seizures are indeed catamenial and to design an appropriate treatment plan.