Laterality and location influence catamenial seizure expression in women with partial epilepsy

Neurology. 2009 Jul 21;73(3):223-7. doi: 10.1212/WNL.0b013e3181ae7adf.

Abstract

Objective: The temporal distribution of seizures in women with localization-related epilepsy occurs periodically according to a model "clock" with the peak phase of occurrence corresponding to menstrual onset. The location and laterality of the epileptic lesion as well as patient age may affect periodicity.

Methods: Baseline data from seizure and menstrual diaries of approximately 3 months duration were obtained from 100 women enrolled in a trial of hormonal therapy for localization-related epilepsy. Durations of individual cycles were normalized to a common menstrual phase and period. Normalized data were then combined to create distributions evaluated by localization (lobar: temporal [TL], extratemporal [XL], multifocal [MF], unknown), lateralization (left, right, bilateral, unknown), and age. Distributions were evaluated with analysis of variance (ANOVA) and curve-fitted by nonlinear least squares cosinor analysis.

Results: A total of 71 patients had TL (left = 25, right = 29, bilateral = 17), 10 XL, 14 MF, and 5 unknown seizure foci. XL and MF seizures occurred randomly across the 28-day cycle. TL seizures (left = 875, right = 706) occurred nonrandomly (ANOVA p = 0.0003) and cyclically with peak occurrence near onset of menses ([value +/- SD] peak = 1.6 +/- 2.3 days, period = 27.0 days). Left-side TL seizures peaked cyclically at onset of menses (ANOVA p = 0.04, peak = 0.0 +/- 3.0 days, period = 30 days); right-side TL seizures occurred randomly. Age did not have a cyclical effect. Women below the median age had a significantly higher seizure rate than those above the median age.

Conclusion: Circalunar rhythms of seizures in women, and therefore, possibly strategies of hormonal treatments of catamenial epilepsy, vary with the neuroanatomic substrate of the seizure focus.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Age Factors
  • Cerebrum / pathology
  • Cerebrum / physiopathology*
  • Cohort Studies
  • Epilepsies, Partial / drug therapy
  • Epilepsies, Partial / pathology
  • Epilepsies, Partial / physiopathology*
  • Epilepsy / drug therapy
  • Epilepsy / pathology
  • Epilepsy / physiopathology*
  • Epilepsy, Temporal Lobe / drug therapy
  • Epilepsy, Temporal Lobe / pathology
  • Epilepsy, Temporal Lobe / physiopathology*
  • Female
  • Functional Laterality / physiology*
  • Humans
  • Hypothalamo-Hypophyseal System / metabolism
  • Hypothalamo-Hypophyseal System / physiopathology
  • Menstrual Cycle / physiology*
  • Menstruation Disturbances / physiopathology
  • Middle Aged
  • Periodicity
  • Progesterone / therapeutic use
  • Prospective Studies
  • Young Adult

Substances

  • Progesterone