Catamenial Epilepsy: A Review

Abstract

Catamenial epilepsy (CE) is a subtype of epilepsy that occurs in women who have reached reproductive maturity. CE is indicated by the exacerbation of seizure frequency and severity in relation to the fluctuation of the female reproductive hormones estrogen and progesterone during the menstrual cycle. Estrogen has been shown to exhibit proconvulsant properties and progesterone is hailed as being protective against epileptic activity. The effect that these hormones have on GABA-A and NMDA receptors have been studied and suggested as the main factors in the pathophysiological manifestation of CE. Research suggests that GABA-A plasticity in response to exposure to neurosteroids may explain the neuroprotective effects of progesterone and its potent metabolite allopregnanolone, which has been a strong candidate for drug development. However, CE is considered pharmacoresistant and there is no FDA approved treatment protocol. There is no known definitive cause of CE or how the sensitivity to estrogen and progesterone develops in the brain, and therefore more research needs to be conducted to fully understand the intricacies of catamenial epilepsy to improve patient outcomes and development of effective therapies.