Treatments for seizures in catamenial (menstrual‐related) ep | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

Treatments for seizures in catamenial (menstrual‐related) epilepsy

You can view up to 4 cases without signing up Sign up for unlimited access

Catamenial (menstrual) epilepsy describes a worsening of seizures in relation to the menstrual cycle and may affect around 40% of women with epilepsy.

Current treatment of catamenial epilepsy depends on whether a woman has regular or irregular menstrual periods.

Catamenial epilepsy is common in women with epilepsy, and may have a significant negative impact on quality of life. There is uncertainty regarding which treatment works best and when in the menstrual cycle treatments should be taken. There are also concerns about the possible impact on fertility, the menstrual cycle, bone health, and cardiovascular health. This review aimed to address these issues in order to inform clinical practice and future research.

The aim of this review was to examine the effectiveness of hormonal and non‐hormonal treatments in stopping seizures in women with catamenial epilepsy.

Results

We included four randomised controlled trials of hormonal treatments in the review, two trials evaluating progesterone and two evaluating norethisterone. The treatment was compared to a placebo. We did not find any studies testing non‐hormonal treatments or any studies in women with irregular periods. The four included studies involved a total of 192 women aged 13-45 years experiencing catamenial epilepsy. The included studies did not demonstrate any significant differences between groups when comparing progesterone or norethisterone to placebo for seizure outcomes. The included studies reported limited information on side effects, but women taking progesterone were no more likely to withdraw from the study due to side effects than those receiving placebo.

The evidence is current to July 2021.

Certainty of the evidence

We judged the certainty of the evidence to be very low to moderate, as the included studies provided unclear information on methods of blinding, recruited small numbers of participants, and were inconsistent in reporting treatment outcomes.

Conclusions

We found very limited, mostly low‐certainty evidence, of no difference in seizure outcomes for norethisterone and progesterone versus placebo in women with catamenial epilepsy. Our review highlights an overall lack of information on the effectiveness of a wide range of other hormonal and non‐hormonal treatments currently being used. Further studies in women with catamenial epilepsy are needed in this area.

Read the full Cochrane Review:

1 comment

Sign up to add a comment

More about this case

ResolvedTrending

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ Background\ Epilepsy is a disorder in which unexpected electrical discharges from the brain cause seizures. Approximately one‐third of patients with epilepsy continue to have seizures, despite treatment with presently used (older) antiepileptic drugs (AEDs). In addition, the older AEDs have a lot of adverse effects. Therefore, the development of effective new therapies for the treatment of drug‐resistant seizures is of considerable importance. As a result, a range of new AEDs has been developed as 'add‐on' treatments. Lamotrigine is one of these drugs.\ Aims of the review\ This review aimed to determine the effects of lamotrigine on seizures, adverse effects, cognition (ability to learn and understand) and quality of life compared to placebo controls, when used as an add‐on treatment for people with focal epilepsy that would not respond to existing AEDs. For this update, we did not identify any new studies to add, and thus, the conclusions remain unchanged. The review included 14 randomised controlled trials with a total number of 1806 participants.\ Results\ Lamotrigine, used in combination with other AEDs in patients who have drug‐resistant focal epilepsy can decrease the frequency of seizures further. However, adding lamotrigine to the usual treatment is more often associated with an increase in adverse effects such as unsteadiness (ataxia), dizziness, double vision (diplopia), and nausea.\ Certainty of the evidence\ We assessed the trials with regards to risk of bias and overall we judged them as low to unclear. We rated the certainty of the evidence as high to moderate.\ Conclusions\ Further high‐quality research is needed to fully evaluate the efficacy and tolerability of lamotrigine and compare it with other newer AEDs.\ The evidence is current to 9 March 2020.](https://app.figure1.com/case-detail/203e88c5-85c4-46a4-a33a-83e0f2a8787f)

\ \ Background\ Epilepsy is a common neurological disorder that appears in various forms. Many individuals with epilepsy have satisfactory seizure control with the use of antiepileptic medications. Yet, nearly a third of people with epilepsy suffer from frequent and uncontrolled seizures despite the use of medication, or are unable to tolerate the side effects of those medications. Surgery is an option for some people with uncontrolled seizures, but it is invasive and not suitable for all individuals. As a result, there remains a substantial unmet need for safe, effective therapies for these harder‐to‐treat epilepsies.\ Transcranial magnetic stimulation (TMS) is one of several newer treatments that can potentially offer people with epilepsy a safe and non‐invasive alternative to surgery. Long used as a research tool to study brain function, TMS has also been studied as a possible treatment for a number of nervous system conditions, including epilepsy. This non‐surgical and painless treatment uses induced magnetic currents to regulate brain function in order to reduce the tendency to have seizures.\ Objective\ We aimed in this review to evaluate the evidence for the use of repetitive transcranial magnetic stimulation (rTMS) in individuals with epilepsy compared with other available treatments in reducing seizure frequency, improving quality of life, reducing epileptiform discharges (abnormalities on brain electrographic testing that suggest underlying brain disturbance or seizure tendency), antiepileptic medication use, and side effects.\ Methods\ The latest search for trials was 2 June 2020. We assessed the evidence from eight randomised controlled trials (studies in which participants are assigned to one of two or more treatment groups using a random method) involving a total of 241 participants comparing rTMS to control treatments (sham treatment, antiepileptic medication, or low‐frequency rTMS).\ Results\ Some of the included trials showed that rTMS reduces the number of seizures individuals had compared to before the therapy, but other trials did not show any significant differences in seizure frequency. Four trials showed a reduction in epileptiform discharges following rTMS treatment. One study measured changes in quality of life in seven participants; although not statistically analysed they found that a greater proportion of study participants reported increased quality of life scores with active treatments compared to the sham treatment. One trial reported an increase in antiepileptic medication in a single individual but they had received the control treatment. Side effects were uncommon; the most frequently reported side effect was headache (and the majority of individuals completed the treatment with rTMS). However, one study showed an increase in seizure frequency in two individuals: one during the rTMS treatment (who discontinued the treatment early), and one weeks after the treatment.\ Certainty of the evidence\ Overall, we judged the certainty of the evidence for the main outcome of reduction in seizure frequency to be low due to unclear information in the published papers about study design and the unclear presentation of results. One included study commented on quality of life, but involved only seven participants.\ The evidence is current to June 2020.](https://app.figure1.com/case-detail/240e785d-a0ce-4655-8f0b-0afbd254319d)

[\ \ Background\ Antiepileptic drug treatment following a first seizure still remains a controversial issue. In this review, we summarised evidence about the effects of immediate treatment with antiepileptic drugs compared to control (placebo [an inactive dummy treatment], deferred or no treatment) on seizure recurrence, seizure remission, side effects and mortality (death).\ The evidence is current to May 2019.\ Methods\ Our literature search found six studies (eleven reports) that included children, adults, or both, with a first unprovoked seizure of any type (focal, generalised or unclassified). They compared antiepileptic treatment given immediately after the first seizure versus deferred (delayed) treatment, placebo or no treatment. Some of the studies did not clearly describe their methods, or how many people dropped out of the study. In five out of the six studies, the participants, clinicians and researchers involved in the studies knew which groups participants were in (immediate or delayed treatment). However, as most seizure recurrences were generalised tonic‐clonic seizures, a convulsive type of seizures that is easily recognisable, we do not think that knowing which group the participants were in influenced the results.\ Results\ Compared to controls, participants randomised to immediate treatment had a lower probability of seizure recurrence at one year and at five years (high‐certainty evidence), although there was no difference between immediate treatment and control in terms of five‐year remission at any time.\ Immediate treatment did not contribute to the overall mortality of epilepsy after the first seizure (high‐certainty evidence), but treatment of the first seizure was associated with a significantly higher risk of adverse events. The certainty of the evidence for side effects was moderate to low with variable reporting of the outcome in the included studies; there was moderate‐certainty evidence that immediate treatment may result in more side effects than delayed treatment, but it was unclear if immediate treatment results in more side effects than placebo or no treatment.\ Conclusions\ In conclusion, treatment of the first unprovoked seizure seems to reduce the risk of relapse but does not affect the long‐term prognosis of epilepsy. However, treatment seems to carry a higher risk of side effects. The decision to treat a first unprovoked seizure should be individualised and based on clinical, legal, and sociocultural factors.](https://app.figure1.com/case-detail/4ef83168-9bd5-45f2-abe0-22978f7ea126)

\ \ Cochrane Review; 12 trials (312 women with heavy menstrual bleeding (HMB: defined as more than 80 millilitres (> 80 mL) of blood loss per menstrual cycle), comparing an antifibrinolytic medication with placebo or a different medical therapy.\ Key results\ Antifibrinolytic medication may improve HMB in women aged 15 to 50 years old, without substantially increasing the rate of adverse events. Evidence suggests there is a 40%-50% reduction in the amount of menstrual blood lost per menstrual cycle for participants taking tranexamic acid (TXA). Antifibrinolytic treatment was better at improving HMB loss than other medical treatments, except for the levonorgestrel intrauterine system (LIUS), a plastic device placed in the uterus which releases hormone to prevent conception.\ The evidence suggests that if 10.9% of women taking placebo report an improvement in HMB, 36.3% of women taking TXA will do so.\ TXA probably improves quality of life for women with HMB.\ No evidence was found to suggest that side effects (including life-threatening blood clots) were increased in women taking antifibrinolytic treatment compared to placebo or other treatments for HMB. Two studies measured venous thromboembolic events: unfortunately these studies did not have enough participants to draw any conclusions.\ The evidence was of very low to moderate quality.](https://app.figure1.com/case-detail/6898e395-548b-4162-bc2e-af5e1dc15713)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)