Catamenial Epilepsy

A seizure happens when electrical activity in the brain surges suddenly. The brain and body are affected in different ways depending on where the activity occurs. Epilepsy is a condition that is linked to seizures.

Catamenial epilepsy (CE), also known as menstrual seizures, is linked to a woman's menstrual cycle and related hormone levels in the body. Women with CE often have more seizures during certain times of their cycle. This may include:

  • Just before or during menstruation, or period.
  • During ovulation, the time during the cycle when an egg moves from the ovary and can be fertilized.

Women with CE will generally have seizures throughout their cycle. However, the number of seizures will often increase during a certain time.

Symptoms

Symptoms of a partial seizure caused by catamenial epilepsy may include:

  • Jerking movements
  • Tingling
  • Dizziness
  • Feeling full in the stomach
  • Repeating certain motions
  • Staring
  • Confusion
  • Changes in emotions

Symptoms of a generalized seizure caused by catamenial epilepsy may include:

  • Convulsions
  • Crying out or making a noise
  • Stiffness
  • Jerking or twitching
  • Falling down
  • Loss of consciousness
  • Not breathing
  • Confusion
  • Loss of bladder control
  • Biting the tongue


Causes and Risk Factors

CE is affected by the hormones estrogen and progesterone. The amount of these hormones in the body changes throughout a woman's menstrual cycle.

The drop in progesterone just before menstruation may trigger seizures in women with CE. The rise in estrogen during ovulation may also rigger seizures in women with CE.

Diagnosis

The most useful test in diagnosing seizures is an electroencephalogram (EEG). This records electrical activity in the brain. EEG can show unusual electrical activity patterns. Different types of seizures can be identified with these patterns.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be used to study the condition. These images can also show where the seizure is happening in the brain. The scans can rule out other possible causes such as a stroke.

Women with epilepsy should keep a record of their seizures and menstrual cycles. The doctor will then study these to see if there is any connection between the two.

Treatments

Medication is the most common treatment for CE. This may include:

  • Anti-seizure drugs
  • Drugs to adjust the hormone levels in the body

The dose of anti-seizure medication may be increased just before the time in the cycle that triggers seizures. The goal is to prevent the seizure from happening.

Drugs that can help lower estrogen or raise progesterone levels in the body may also be used. This may include:

  • Oral contraceptives (birth control pill)
  • Natural progesterone
  • Clomiphene

In extreme cases, surgery to remove the ovaries may be used to treat the condition.

The staff at the Cedars-Sinai Epilepsy Program will work with each patient to determine the best treatment option.