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Some ovarian steroids such as estradiol (E)1,2 and progesterone (P)3,4 have neuroactive properties that can affect neuronal excitability. Cyclic changes in the serum concentrations of these steroids in relation to the menstrual cycle may induce variation in seizure frequency that has been termed catamenial epilepsy.5,6 There is statistical evidence to support the existence of at least three patterns: 1) perimenstrual (C1: day −3 to 3), 2) periovulatory (C2: day 10 to −13) in ovulatory cycles, and 3) luteal (C3: day 10 to 3) in anovulatory cycles. Day 1 refers to the day of onset of menstrual flow and Day −14 is presumed to represent the day of ovulation in ovulatory cycles.5,6 There are also mathematically based levels of seizure exacerbation for designation of catamenial epilepsy for each of these patterns. Although different patterns of catamenial exacerbation have been observed with ovulatory and anovulatory cycles, their sensitivity and specificity remain to be established.5,6
Methods.
The subjects were 100 women with localization-related epilepsy, 13 to 45 years of age, who had intractable seizures, i.e., persistence of two or more monthly seizures despite documented trials of at least two antiepileptic drugs with therapeutic range levels. The subjects were participating in the baseline phase of a clinical trial of progesterone therapy. The women recorded …
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