Abstracts

Rationale: Women with catamenial epilepsy show cyclical exacerbation of their seizures with temporal relationship to their menstrual cycles. Seizure exacerbation may occur either at the time of menstruation or ovulation and is attributed to fluctuations of estrogen and progesterone. Catamenial epilepsy is thought to be related to different responses of neurons in the cerebral cortex to sex hormones. The aim of this study was to evaluate seizure types and trends in a population of patients with catamenial epilepsy. Methods: We performed retrospective analysis of a database of 567 adult epilepsy patients who were evaluated and treated from 2004 to 2010 at the Comprehensive Epilepsy Center of University at Buffalo. Women were given a standard questionnaire which included questions regarding significant exacerbation of their seizures associated with their menstrual cycle. Determination of catamenial epilepsy was based on patient s response to the questionnaire as well as their monthly seizure calendar which specified number of seizures in relation to the time of ovulation or onset of menstruation. We evaluated the female patients less than 50 years of age with catamenial epilepsy for their type of epilepsy, seizure frequency, response to medications, neuroimaging findings, and seizures during their pregnancies.Results: Out of 567 adult epilepsy patients, 217 were female of reproductive age and less than 50 years of age (Range 19-50). Twenty-six females were qualified for a diagnosis of catamenial epilepsy, 17 of which were diagnosed with partial epilepsy (65%) and 9 with primary generalized epilepsy (35%). Nineteen out of 26 catamenial epilepsy patients had medically refractory epilepsy (73%) compared with a rate of 37% in female patients of the same age with non-catamenial epilepsy (70 out of 191 patients). Fourteen patients had abnormalities on their MRI ranging from hippocampal atrophy (4), cortical malformations (2), encephalomalacia (2) and other abnormalities (6). Six out of 8 patients who had children reported experiencing more seizures during their pregnancy.Conclusions: Women with catamenial epilepsy in our tertiary care epilepsy population had a much higher frequency of medically refractory and lesional epilepsy compared with general population. There were a higher percentage of patients with primary generalized epilepsy in our catamenial epilepsy patients as compared with the expected rate in general population. Our patients with catamenial epilepsy tended to experience seizure exacerbation during their pregnancies.