Overview:

Catamenial epilepsy is a type of epilepsy in which seizures occur at certain parts of the menstrual cycle. Women with catamenial epilepsy are unusually sensitive to endogenous hormonal changes. Estrogen appears to be a proconvulsant while progesterone seems to have the opposite effect.This seizure exacerbation has a statistically significant positive correlation to serum estrogen and progesterone levels and ratios. Charting out menses against seizure occurrence and type can establish this pattern. There are three types of catamenial epilepsy: perimenstrual, preovulatory, and anovulatory.

Findings that Support the Diagnosis:

The patient's seizures occur at fairly reliable intervals raising the possibility that they are tied to her menstrual cycle and associated hormonal fluctuations. Also, no general seizures occured during pregnancy. Pregnancy is known to change many organ systems and does affect seizure threshold (although differently in different people; some increase, some decrease).

Findings that Argue Against the Diagnosis:

Many men and women have seizures with a certain periodicity. The timing of the seizures in this patient does not seem to precisely overlay the menstrual cycle or follow hormone levels. While we do not have enough data regarding the timing of menses, in May 2011 the patient's cycle was 30 days. The interval between general seizures is approximately 50 days. Also, during the month long hormone monitoring, no seizures occured in periods of highest estrogen but did occur on 3/25/11 where progesterone was much higher than estrogen.

Follow Up:

More data about menstrual cycle timing in relation to seizure activity may be marginally helpful in establishing a diagnosis of catamenial epilepsy. This should only be pursued if considering a treatment that is tailored to catamenial epilepsy, such as hormonal therapy. It should be noted that even cases of catamenial epilepsy are treated with traditional anti-epileptic drugs.

Questions:

Is the patient contemplating hormonal therapy if seizures are linked to menstrual cycle hormones?

Action Plan:

Attempts should be made to control seizures. Anti-eplieptic drugs are most likely to be of benefit regardless of whether seizures are linked to sex hormone variation.

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