Abstracts

RATIONALE: Hormonal changes associated with menopause are factors that could potentially influence the onset of seizures in mature or older women. This study examines the causes of new onset seizures in women during menopause and compares those causes to the etiologies of seizures in similarly aged men. METHODS: We identified all women with seizures beginning around menopause seen at the University of Maryland Medical Center between the years 1994 and 2000. Only patients with recurrent unprovoked epileptic seizures were included. Menopause was defined as the absence of periods for 12 months, and women were divided into two groups: 1) peri-menopausal (those with menopausal symptoms or within two years of menopause)and 2)post-menopausal (two years or more after menopause). The causes of seizures were then categorized as a) symptomatic or b) cryptogenic (idiopathic), and the etiologies in women were compared to those in age matched (within 3 years) male controls from the same patient population. RESULTS: We identified 22 women with new onset seizures in or around menopause. In 12 of the women epilepsy began peri-menopausally (group 1). For 10 of these 12 women (73%), their seizures were judged to be cryptogenic, with no identifiable cause. In contrast, age matched male controls had no identifiable cause in only 17% of patients, and this difference is statistically significant (p=0.0017). In addition, such a difference between men and women was not found for women who were much beyond the onset of their menopause. Among the 10 postmenopausal women (group 2), who were generally older than the peri-menopausal group, a cause for seizures could be identified in 7 (70%), the majority, and there was no significant difference compared to age matched male controls. CONCLUSIONS: Epilepsy beginning in or around the onset of menopause is a significant problem that cannot be entirely attributed to other causative factors. Indeed, we propose that there may be a "menopausal epilepsy," perhaps similar conceptually to "gestational epilepsy," in which hormonal influences play a significant role in the new onset of seizures in some women.