Premenstrual seizure increase influence of age, duration of disease, seizure frequency, previous complaint of perimenstrual accentuation, eeg and ct scan findings

Gueirreiro, Carlos A. M.; Ramos, Marcelo C.

doi:10.1590/S0004-282X1991000100004

Abstracts

We selected prospectively 80 mentally healthy women at menacme age, with chronic epilepsy and at least one seizure in the month preceding this study. They underwent four EEGs weekly. CT scan of the skull was done in 57 patients (71.25%). Seven patients were excluded because they had no seizures or menses. We registered 5630 seizures during 579 regular menstrual cycles over a 30 month period. RESULTS: - there was a higher incidence of seizures in the premenstrual period (p<0.001); - age did not influence the distribution of seizures during the menstrual cycle in the group studied; - patients with 11 or more years of disease showed more accentuation of premenstrual seizures than patients with 10 or less years of disease; - there was no relation between the patients frequency of seizures and the occurrence of premenstrual seizures; - the patients impression of the incidence of seizures not related to menstruation was not confirmed; - patients with abnormal skull CT scans had more accentuation of premenstrual seizures than patients with normal exams; - patients with abnormal EEGs had more premenstrual seizures than patients with normal exams. Our findings suggest that the female sexual hormones alter cerebral excitability when there is an underlying structural pathology shown by CT scan or an electrical cerebral dysfunction revealed by EEG.

Selecionamos prospectivamente 80 mulheres epilépticas, sem aparente distúrbio comportamental ou retardo mental, na menacme, com crises epilépticas não completamente controladas. Foram submetidas a 4 EEGs com intervalos semanais. CT-scan de crânio foi realizado em 57 pacientes (71,25%). Sete pacientes foram excluídas por não apresentarem crises ou menstruações, ou por colaboração insatisfatória. Foram registradas 5630 crises epilépticas em 579 ciclos menstruais regulares durante 30 meses. RESULTADOS: - houve maior incidência de crises epilépticas no período peri-menstrual: - a idade não influenciou na distribuição de crises durante o ciclo menstrual no grupo estudado; - pacientes com 11 ou mais anos de doença mostraram maior tendência a crises no período pré-menstrual que pacientes com 10 ou menos anos de_ doença; - não houve relação entre a freqüência das crises e a ocorrência de crises pré-menstruais; - a negativa da referência prévia de piora peri-menstrual pela paciente não mostrou ser dado relevante; - pacientes cujos CT scan foram anormais tiveram tendência a ter crises no período pré-menstrual; - pacientes com EEGs anormais tiveram mais crises no período pré-menstrual quando comparadas às pacientes com EEGs normais. Nossos achados sugerem que os hormônios sexuais femininos modifiquem a excitabilidade cortical, particularmente quando há prévio comprometimento estrutural evidenciado pelo CT-scan ou disfunção elétrica cerebral, pelo EEG.

CONTENTS CONTEÚDO

Carlos A. M. Gueirreiro; Marcelo C. Ramos

Department of Neurology, Campinas University (UNICAMP). Paper presented in part at the 18th International Epilepsy Congress (New Delhi, October 1989).

SUMMARY

We selected prospectively 80 mentally healthy women at menacme age, with chronic epilepsy and at least one seizure in the month preceding this study. They underwent four EEGs weekly. CT scan of the skull was done in 57 patients (71.25%). Seven patients were excluded because they had no seizures or menses. We registered 5630 seizures during 579 regular menstrual cycles over a 30 month period.

RESULTS: - there was a higher incidence of seizures in the premenstrual period (p<0.001); - age did not influence the distribution of seizures during the menstrual cycle in the group studied; - patients with 11 or more years of disease showed more accentuation of premenstrual seizures than patients with 10 or less years of disease; - there was no relation between the patients frequency of seizures and the occurrence of premenstrual seizures; - the patients impression of the incidence of seizures not related to menstruation was not confirmed; - patients with abnormal skull CT scans had more accentuation of premenstrual seizures than patients with normal exams; - patients with abnormal EEGs had more premenstrual seizures than patients with normal exams. Our findings suggest that the female sexual hormones alter cerebral excitability when there is an underlying structural pathology shown by CT scan or an electrical cerebral dysfunction revealed by EEG.

RESUMO

Selecionamos prospectivamente 80 mulheres epilépticas, sem aparente distúrbio comportamental ou retardo mental, na menacme, com crises epilépticas não completamente controladas. Foram submetidas a 4 EEGs com intervalos semanais. CT-scan de crânio foi realizado em 57 pacientes (71,25%). Sete pacientes foram excluídas por não apresentarem crises ou menstruações, ou por colaboração insatisfatória. Foram registradas 5630 crises epilépticas em 579 ciclos menstruais regulares durante 30 meses.

RESULTADOS: - houve maior incidência de crises epilépticas no período peri-menstrual: - a idade não influenciou na distribuição de crises durante o ciclo menstrual no grupo estudado; - pacientes com 11 ou mais anos de doença mostraram maior tendência a crises no período pré-menstrual que pacientes com 10 ou menos anos de_ doença; - não houve relação entre a freqüência das crises e a ocorrência de crises pré-menstruais; - a negativa da referência prévia de piora peri-menstrual pela paciente não mostrou ser dado relevante; - pacientes cujos CT scan foram anormais tiveram tendência a ter crises no período pré-menstrual; - pacientes com EEGs anormais tiveram mais crises no período pré-menstrual quando comparadas às pacientes com EEGs normais. Nossos achados sugerem que os hormônios sexuais femininos modifiquem a excitabilidade cortical, particularmente quando há prévio comprometimento estrutural evidenciado pelo CT-scan ou disfunção elétrica cerebral, pelo EEG.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. Carlos A. M. Guerreiro - Departamento de Neurologia, UNICAMP - Caixa Postal 6111 -13081 Campinas SP - Brasil.

1. Ansell B, Clark E. Epilepsy and menstruation : the role of water retention. Lancet 2:1232-1235, 1956.
2. Backstrom T. Epileptic seizures in women related to plasma estrogen and progesterone during the menstrual cycle. Acta Neurol Scand 54:321-347, 1976.
3. Backstrom T, Zetterlund B, Blom S, Romano M. Effects of intravenous progesterone infusions on the epileptic discharge frequency in women with parcial epilepsy. Acta Neurol Scand 69:240-248, 1984.
4. Bailey AA. Treatment of epileptic disorders of adults. Mayo Clin Proc 28:39-44, 1953.
5. Bandler B, Kaufman C, Dykens JW, Schleifer M, Shapiro LN. Seizures and the menstrual cycle. Am J Psychiat 113:704-708, 1957.
6. Bauer G, Mayr U, Pallua A. Computerized axial tomography in chronic partial epilepsies. Epilepsia 21:227-233, 1980.
7. Blyth W. The pitressin diagnosis of idiopathic epilepsy Br Med J 1 :100-102, 1943.
8. Bogdanoff BM, Stafford CR, Green L, Gonzalez CF. Computerized transaxial tomography in the evaluation of patients with focal epilepsy. Neurology 25 : 1013-1017, 1975.
9. Dodrill CB. Correlation of generalized tonic-clonic seizures with intellectual, neuropsychological, emotional, and social function in patients with epilepsy. Epilepsia 27:399-411, 1986.
10. Dreifuss FE. Goals surgery for epilepsy. In Engel J Jr (ed) : Surgical Treatment of the Epilepsies. New York: Raven Press, 1987, p 31-49.
11. Garcia CR, Rock J. Ovulation. In Velardo JT (ed) : Essentials of Human Reproduction Clinical Aspects. Normal and Abnormal, New York: Oxford TJniv Press, 1958, p 22-54.
12. Gastaut H. Conclusions: computadorized transverse axial tomography in epilepsy. Epilepsia 17:337-338, 1976.
13. Gastaut H, Gastaut JL. Computadorized transverse axial tomography in epilepsy. Epilepsia 17:325-336, 1976.
14. Gowers WR. Epilepsy and Other Chronic Convulsive Diseases: Their Causes, Symptoms, and Treatment. New York: William Wood, 1885.
15. Guerreiro CAM, Ramos MC, Quagliato EMAB. Ciclo menstrual e crises epilépticas, Rev Paul Med 105:72-74, 1987.
16. Laidlaw J. Catamenial epilepsy. Lancet 271:12-35-1237, 1956.
17. Logothetis J, Harner R, Morrei P, Torres F. The role of estrogens in catamenial exacerbation of epilepsy. Neurology 9:352-360, 1959.
18. Marcus EM, Watson CW, Goldman PL. Effects of steroids on cerebral electrical activity: epileptogenic effects of conjugated estrogens and related compounds in the cat and rabbit. Arch Neurol 15:521-532, 1966.
19. Mattson RH, Kamer JA, Caldwell BV, Cramer JA. Seizure frequency and the menstrual cycle: a clinical study (Abstr). Epilepsia 22:242, 1981.
20. McGahan JP, Dublin AB, Hill RP. The evaluation of seizure disorders by computerized tomography. Neurosurg 50:328-332, 1979.
21. Millichap JG. Systemic electrolyte and neuroendocrine mechanisms. In Jasper HH, Ward AA Jr, Pope A (eds) : Basic Mechanisms of the Epilepsies Boston: Little Brown, 1969, p 109-126.
22. Moseley IF, Bull WD. Summary : computerized transverse axial tomography in epilepsy. Epilepsia 17:339-342, 1976.
23. Newmark ME, Penry JK. Catamenial epilepsy: a review. Epilepsia 21:281-300, 1980.
24. Neugebauer R, Zybert P, O Connor P, Hauser WA, Leppik IE, Berlin M, Bregstein J, Lavine J, Michalow M, Wicks J. Reliability and validity of patients daily seizure and event reports. In Porter RJ, Mattson RH, Ward AA Jr, Dam M (eds) : Advances in Epileptology: XVth Epilepsy Internacional Symposium New York: Raven Press, 1984, p 535-539.
25. Phelps D. Menstruation. In Velardo JT (ed) : Essentials of Human Reproduction Clinical Aspects. Normal and Abnormal. New York: Oxford Univ Press, 1958, p 55-87.
26. Quagliato EMAB. Forma epiléptica da cisticercose encefálica: análise de 96 casos. Tese de Doutoramento, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. Campinas, 1987.
27. Rosciszewska D, Buntner B, Guz I, Zawisza L. Ovarian hormones, anticonvulsants drugs, and seizures during the menstrual cycle in women with epilepsy. J Neurol Neurosurg Psychiat 49:47-51, 1986.
28. Schatz PT. Neuroendocrinology and the ovulation cycle; advances and review. Adv Psychosom Med 12:4-24, 1985.
29. Shavit G, Lerman P, Korczyn AD, Kivity S, Bechar M, Gitter S. Phenytoin pharmacokinetics in catamenial epilepsy. Neurology 34:959-961, 1984.
30. Velardo JT. Endocrines and reproduction. In Velardo JT (ed) : Essential of Human Reproduction: Clinical Aspects. Normal and Abnormal. New York: Oxford Univ Press, 1958, p 3-31.

Premenstrual seizure increase influence of age, duration of disease, seizure frequency, previous complaint of perimenstrual accentuation, eeg and ct scan findings

Aumento pré-menstrual de crises epilépticas: importância da idade, duração da doença, frequência das crises, queixa prévia de piora perimenstrual das crises, resultado do CT e do EEG.

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
Mar 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ansell B, Clark E. Epilepsy and menstruation : the role of water retention. Lancet 2:1232-1235, 1956.

[2] 2. Backstrom T. Epileptic seizures in women related to plasma estrogen and progesterone during the menstrual cycle. Acta Neurol Scand 54:321-347, 1976.

[3] 3. Backstrom T, Zetterlund B, Blom S, Romano M. Effects of intravenous progesterone infusions on the epileptic discharge frequency in women with parcial epilepsy. Acta Neurol Scand 69:240-248, 1984.

[4] 4. Bailey AA. Treatment of epileptic disorders of adults. Mayo Clin Proc 28:39-44, 1953.

[5] 5. Bandler B, Kaufman C, Dykens JW, Schleifer M, Shapiro LN. Seizures and the menstrual cycle. Am J Psychiat 113:704-708, 1957.

[6] 6. Bauer G, Mayr U, Pallua A. Computerized axial tomography in chronic partial epilepsies. Epilepsia 21:227-233, 1980.

[7] 7. Blyth W. The pitressin diagnosis of idiopathic epilepsy Br Med J 1 :100-102, 1943.

[8] 8. Bogdanoff BM, Stafford CR, Green L, Gonzalez CF. Computerized transaxial tomography in the evaluation of patients with focal epilepsy. Neurology 25 : 1013-1017, 1975.

[9] 9. Dodrill CB. Correlation of generalized tonic-clonic seizures with intellectual, neuropsychological, emotional, and social function in patients with epilepsy. Epilepsia 27:399-411, 1986.

[10] 10. Dreifuss FE. Goals surgery for epilepsy. In Engel J Jr (ed) : Surgical Treatment of the Epilepsies. New York: Raven Press, 1987, p 31-49.

[11] 11. Garcia CR, Rock J. Ovulation. In Velardo JT (ed) : Essentials of Human Reproduction Clinical Aspects. Normal and Abnormal, New York: Oxford TJniv Press, 1958, p 22-54.

[12] 12. Gastaut H. Conclusions: computadorized transverse axial tomography in epilepsy. Epilepsia 17:337-338, 1976.

[13] 13. Gastaut H, Gastaut JL. Computadorized transverse axial tomography in epilepsy. Epilepsia 17:325-336, 1976.

[14] 14. Gowers WR. Epilepsy and Other Chronic Convulsive Diseases: Their Causes, Symptoms, and Treatment. New York: William Wood, 1885.

[15] 15. Guerreiro CAM, Ramos MC, Quagliato EMAB. Ciclo menstrual e crises epilépticas, Rev Paul Med 105:72-74, 1987.

[16] 16. Laidlaw J. Catamenial epilepsy. Lancet 271:12-35-1237, 1956.

[17] 17. Logothetis J, Harner R, Morrei P, Torres F. The role of estrogens in catamenial exacerbation of epilepsy. Neurology 9:352-360, 1959.

[18] 18. Marcus EM, Watson CW, Goldman PL. Effects of steroids on cerebral electrical activity: epileptogenic effects of conjugated estrogens and related compounds in the cat and rabbit. Arch Neurol 15:521-532, 1966.

[19] 19. Mattson RH, Kamer JA, Caldwell BV, Cramer JA. Seizure frequency and the menstrual cycle: a clinical study (Abstr). Epilepsia 22:242, 1981.

[20] 20. McGahan JP, Dublin AB, Hill RP. The evaluation of seizure disorders by computerized tomography. Neurosurg 50:328-332, 1979.

[21] 21. Millichap JG. Systemic electrolyte and neuroendocrine mechanisms. In Jasper HH, Ward AA Jr, Pope A (eds) : Basic Mechanisms of the Epilepsies Boston: Little Brown, 1969, p 109-126.

[22] 22. Moseley IF, Bull WD. Summary : computerized transverse axial tomography in epilepsy. Epilepsia 17:339-342, 1976.

[23] 23. Newmark ME, Penry JK. Catamenial epilepsy: a review. Epilepsia 21:281-300, 1980.

[24] 24. Neugebauer R, Zybert P, O Connor P, Hauser WA, Leppik IE, Berlin M, Bregstein J, Lavine J, Michalow M, Wicks J. Reliability and validity of patients daily seizure and event reports. In Porter RJ, Mattson RH, Ward AA Jr, Dam M (eds) : Advances in Epileptology: XVth Epilepsy Internacional Symposium New York: Raven Press, 1984, p 535-539.

[25] 25. Phelps D. Menstruation. In Velardo JT (ed) : Essentials of Human Reproduction Clinical Aspects. Normal and Abnormal. New York: Oxford Univ Press, 1958, p 55-87.

[26] 26. Quagliato EMAB. Forma epiléptica da cisticercose encefálica: análise de 96 casos. Tese de Doutoramento, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. Campinas, 1987.

[27] 27. Rosciszewska D, Buntner B, Guz I, Zawisza L. Ovarian hormones, anticonvulsants drugs, and seizures during the menstrual cycle in women with epilepsy. J Neurol Neurosurg Psychiat 49:47-51, 1986.

[28] 28. Schatz PT. Neuroendocrinology and the ovulation cycle; advances and review. Adv Psychosom Med 12:4-24, 1985.

[29] 29. Shavit G, Lerman P, Korczyn AD, Kivity S, Bechar M, Gitter S. Phenytoin pharmacokinetics in catamenial epilepsy. Neurology 34:959-961, 1984.

[30] 30. Velardo JT. Endocrines and reproduction. In Velardo JT (ed) : Essential of Human Reproduction: Clinical Aspects. Normal and Abnormal. New York: Oxford Univ Press, 1958, p 3-31.