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(Abst. 1.216), 2017

Does the Age of Seizure Onset Relate to Menarche?
Authors: Devon B. MacEachern, Beth Israel Deaconess Medical Center; Raya Husami, Beth Israel Deaconess Medical Center; and Andrew G. Herzog, Beth Israel Deaconess Medical Center
Content: Rationale: Whether the age of menarche differs between women with epilepsy (WWE) and women in the general population (WGP) and whether the age of seizure onset relates temporally to the age of menarche has been a focus of controversy.  A relationship could implicate an important modifiable neuroendocrine factor. Methods: These retrospective data come from the Epilepsy Birth Control Registry (EBCR) web-based survey of 1144 WWE in the community, ages 18-47 years, who provided demographic, epilepsy, antiepileptic drug (AED), reproductive and contraceptive data.  We report the mean ages with 95% confidence intervals and frequency distributions of the ages of menarche and seizure onset in WWE.  We compare the mean age to general population data using the 95% confidence intervals and independent t-tests.  We assess the relationship between the age of seizure onset and age of menarche by 1) goodness of fit of the observed versus expected frequencies, 2) two step cluster analysis of the distribution of the differences between the age of seizure onset and the age of menarche and 3) GLM univariate ANOVA assessment of the age of menarche as a predictor of the age of seizure onset and the percentage of the variance (R2 value) that menarche explains. Results: The average age of menarche in the EBCR survey is 12.55 years (95% CI: 12.45-12.65) with peak age of 13 (26.0%) and range of 8-20.  The mean is similar to that of WGP during the years most pertinent to the EBCR study, 12.54 (12.44–12.64).  The mean age was significantly but not substantially greater in WWE who had their age of seizure onset before menarche as compared to after menarche (12.70 [12.54-12.86] v 12.42 [12.30-12.54], t-test p = 0.006.  The ranges were very similar 8-20 versus 8-19 respectively.  The average age of seizure onset in WWE was 14.13 years (95% CI: 13.69-14.61) with peak age of 15 (7.1%) and range 0-42.  More WWE had seizure onset during the year of menarche than during any other year, significantly more than randomly expected (95/1144, 8.3% v expected 23/1144, 2.0%; p Conclusions: Although the results indicate a significant relationship between the age of seizure onset and the age of menarche, the identification of a cluster that spans the 2 years before through 6 years after menarche and accounts for 49.3% of seizure onset, suggests a more complex relationship, perhaps implicating the combined effects of adrenarche and menarche which span these years and are accompanied by a great increase in the production of neuroactive steroids that modulate neuronal excitability and seizures. Funding: Epilepsy Foundation and Lundbeck
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