Abstracts

Rationale: Catamenial Epilepsy (CE) is a condition characterized by spontaneous recurrent seizures with an increase in the frequency of seizures during a specific stage of the menstrual cycle compared to baseline. The fluctuation of estrogen levels is believed to play a role in the pathogenesis of catamenial epilepsy. The objective was to describe RNS-related Electrocorticography (ECoG) findings through a case report thereby providing an objective understanding of the catamenial pattern of seizures. With this information, a more targeted approach to management can be adopted.

Methods: We report the clinical findings of a woman with medically intractable left temporal lobe epilepsy (TLE) who underwent presurgical evaluation and RNS implantation. Scalp EEG, neuroimaging findings, ictal onset localization and RNS-ECoG findings were reviewed and reported.


Results: A 39-year-old right-handed woman with medically intractable TLE had clinical semiology of focal seizures with loss of awareness and auras of De Ja Vu. MRI was negative for any structural lesions. On scalp EEG, she was found to have epileptogenic zone in left temporal hippocampus with propagation to the rest of left hemisphere. She had RNS implantation with leads in left hippocampus and Para hippocampus, with significant frequency reduction in her habitual seizures from 6-8 focal seizures/month to 2-3. Interestingly, RNS-ECOG recorded two different patterns of seizures. Pattern 1: seizures originating in the left hippocampus without parahippocampal propagation lasting 30-40 seconds occurring 1-2/month unrelated to menses onset, with clinical loss of awareness. Pattern 2: focal seizure with aura originating in the left hippocampus with propagation to the parrahippocampus lasting 2 minutes occurring in 3 to 4 times a month perimenstrual only.


Conclusions: Catamenial Epilepsy (CE)is underdiagnosed in women with focal or generalized epilepsy. Although historically ASM options for CE have been limited, RNS offers an exciting new diagnostic paradigm in which detection of recurrent seizures related to menstrual cycle is possible and therapy may be tailored specifically for each patient.


Funding: No funding source.