Differential Effects of the Menstrual Cycle on Specific Seizure Types and Epilepsy Syndromes
Abstract number :
3.156
Submission category :
Year :
2001
Submission ID :
2013
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
W.A. Waldman, MD, Neurology, University of Virginia, Charlottesville, VA; N.B. Fountain, MD, Neurology, University of Virginia, Charlottesville, VA; C. Schwaner, Neurology, University of Virginia, Charlottesville, VA
RATIONALE: Reproductive hormones are known to influence seizure frequency, but the specific effects on various seizure types and epilepsy syndromes is not well understood. We examined the self-reported frequency of menstrual cycle as a precipitant to seizures in women with well-defined seizure types and epilepsy syndromes.
METHODS: We prospectively interviewed 1105 consecutive patients seen in our epilepsy clinic to determine whether or not they reported a worsening of seizures in association with various precipitant[ssquote]s, including their monthly menstrual cycle (MC). We selected 330 consecutive female patients between ages 12 and 45 who had clinically definite seizures. Seizure type and epilepsy syndrome were classified according to ILAE criteria. Seizure types were further grouped into partial only, generalized only, or mixed generalized and partial. Generalized epilepsy syndromes were categorized as idiopathic (IGE), symptomatic (SGE), or cryptogenic (CGE); and partial (localization-related) epilepsy syndromes were categorized similarly as IPE, SPE, or CPE. Chi-square analysis was used to determine whether MC as a precipitant was reported more often in specific groups.
RESULTS: Overall, 16% reported MC as a precipitant. Among seizure groups, MC was more often reported as a precipitant by patients with partial (22%) than generalized (8%; p=.004) seizures. Among epilepsy syndrome categories, MC was most often reported as a precipitant by patients with SPE (26%) and least often by IGE (7%; p=.03). Among specific epilepsy syndromes, MC was most often reported as a precipitant by patients with temporal lobe epilepsy (30%) and least often with juvenile myoclonic epilepsy (13%; p=.002)
CONCLUSIONS: Reproductive endocrine effects on seizure occurrence are greater for partial than generalized seizures and even greater for patients with TLE. This suggests that the underlying mechanisms of reproductive endocrine effects act on pathophysiologic neuronal changes specific to TLE rather than having non-specific activating effects on partial seizures. Strategies that modify reproductive hormones are more likely to benefit women with partial seizures due to TLE than other seizure types or epilepsy syndromes.
Support: NINDS 01992 (NBF).