Seizures during the menstrual cycle

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I agree with you KAM.
I was told by Rebecca's neurologist that certain AED's increase in strength during the TOM, while others decrease. I guess even that could change per individual as well.
My only remaining goal with "E" is to get this answer, to get it confirmed with the Medical Board. I wish I knew now what was speculation then; it was my period . I gave up a good portion of my temporal lobe to get rid of seizures only to find out my memory is for crap, and maybe every answer I have an answer for is in a jar in Miami, if you feel the period is your cause, don't let anyone tell you different. Most important, don't let them operate!
This is what I seriously believe is my main problem! Horomones! If I look back at allllll the times I "called/emailed in" at my job, I can bet that It was within two weeks before/during my period! That is when I have the most seizures, panic attacks, ect.., Today was a really good day guys! I have no memory of anything I did all morning, but today was one of the best days! I can't sleep now, but it was still a good day! No auras, no staring, no passing out, good blood glucose levels! A good, good day!
Nice to know...

..that I'm not the only one. I have a 25 day cycle, and I'm guaranteed to have a seizure within a week of my period. Now the weird thing is, I went from having a 7 day period in my 20's to a 2 day period when I hit 36. My doc just shrugs and says, "It doesn't matter how long it is, it just matters that you have it." I'm wondering if that's not from using Depo Provera in my early 20's. Oh well. At least I'm not alone. And you know what? In a weird way, that's really comforting. :)
Get some hormonal tests done. Estrogen excites the brain. Progesterone calms the brain.
I had a monthly hormonal migraines for 30 yrs that was "cured" when I began taking magnesium, COQ10, and got my hormones balanced again.
Oh... the only other time I did not have migraines was when I was pregnant.
*chuckle* they did hormone tests and said I was just fine.......Who knows...maybe I'm just getting ready for menopause?
I had one doctor that looked at me and said of course you are perimenopausal. Then I went to a doctor that specializes in hormones, and he did some specialized blood work and said, "Nope... not yet." So I use a bio identical hormone and life is a lot better. I think I am older than you are. Rebecca had the same blood test taken, and we did an ovulation test (thermometer chart) and she was not producing progesterone. She is also on bio identical progesterone. She does not have seizures centered around her cycle anymore if she is careful about using the cream.
Hi, I'm "Premium Irregular" (that should have
been my User ID), and majority of the seizures
that strikes is very much right before the cycle
begins. Even though I do have a medical history
but back in the past that wasn't looked upon
until recently, and since part of 06 and the
entire 07 - they've been looking at it closely
and comparing it with the past and seeing the
pattern. They have not yet been able to pin-
point the reason; except that it strikes the
hardest during Fall (Autumn) and Winter; like
a Florida "Hurricane Season" - and now are
believing the natural sunlight also has an
effect as well on the cycle phase. We will
have to see how 2008 cycle looks like. It is
interesting in a lot of ways but they are not
sure why but looking at the past and current
they can see it all now.

It does not have anything to do with Holidays
or Stress for it my "Hurricane Season" starts
from Aug/Sept - Feb/Mar and has the peak
time during that same time around just around
the Holidays or after it. It is also the same time
when I can go for long stretches before my
next cycle begins (for example in 2007, my
last cycle was in Oct and went 53 days before
the next one started in Dec and it triggered
everything; and it was also the "Peak" of the

During the off-peak season, the seizures
are typically very mild or I would experience
auras without any seizures or none at all.
And if I had a seizure, it was usually provoked:
such as lack of sleep, overly tired, etc.

Good news is the Doctors are finally getting to
the bottom line of it all.
Dear Bunkers1,

>Would that be catamenial epilepsy or would you not know that?

From what I know epilepsy is catamenial only if your seizures ALWAYS come during your period. So if your seizures are only more frequent and/or stronger during the period, this is not a catamenial epilepsy (it's just like the other problems who tend to be more explicit during the period).
For epilepsy to count as catamenial, this link should be extremely strong: for example, I've never ever had an seizure without having my period too.
Lovies1023, Glad you had a good day! Hope they continue. I'm going through the same thing you are. Other then insomnia, PMS triggers most of my seizures. If my neurologist had a agreed with my 'gut' I would have studied the connection between hormones and seizures a long time ago. At least now I know I'm not alone. Take care.
Hi RobinN, If hormone imbalances are triggering seizures for lots of women including myself, wouldn't it be more logical for our doctors to focus on balancing them(hopefully with natural means instead of meds) instead of prescribing meds? In other words, could the meds be adding to the problem at 'that time of the month'? Hope that's not a stupid question. I've read about Hormone replacement therapy to balance hormones but I've also heard some negative things about it and it scares me. Do you have any opinions on HRT?
It is not a stupid question at all.
I was told by Rebecca's doctor that some meds actually increase during the TOM while others decrease their effectiveness. That gave me the same sorts of questions that you are asking here.

I do have an opinion. I read about HRT and many are synthetic. It is not anywhere near what is called for in the research of catamenial seizures. They found in studies that it needed to be bio-identical hormones. This is what is being prescribed by Rebecca's neurologist. Of course these are not regulated by the FDA so the pharmaceutical companies are trying to get them banned. They want them "monitored". We are no longer smart enough to monitor when we feel better or not I guess.

I agree with you... if the seizures are being triggered by hormones then it is my opinion that they should be balanced using natural methods.

The opposing effects of estrogen (proconvulsant) and progesterone (anticonvulsant) on seizure threshold have been noted in animal and human studies. Levels of these hormones fluctuate throughout the menstrual cycle, and, in some women with epilepsy, these fluctuations may be related to the occurrence of seizures around the time of menses or an increase in seizures in relation to the menstrual cycle, also known as catamenial epilepsy. Variations in concentrations of antiepileptic drugs across the menstrual cycle may also contribute to increased seizure susceptibility. Diagnosis of catamenial epilepsy requires careful assessment of menstrual and seizure diaries and characterization of cycle duration and type. While there are several approaches to the treatment of catamenial epilepsy, each is based on small, unblinded studies or anecdotal reports. It is important for the physician to work closely with the patient to determine whether her seizures are indeed catamenial and to design an appropriate treatment plan.$=relatedreviews&logdbfrom=pubmed
Seizures do not occur randomly. They tend to cluster in the majority of men and women with epilepsy. Seizure clusters, in turn, often show a periodicity. When the periodicity of seizure exacerbation aligns itself with that of the menstrual cycle, it is designated as catamenial epilepsy. The neuroactive properties of reproductive steroids and the cyclic variation in their serum concentrations are important pathophysiologic factors. Recent investigations have demonstrated and confirmed the existence of at least three patterns of catamenial seizure exacerbation: perimenstrual and periovulatory in ovulatory cycles and entire luteal phase in anovulatory cycles. A rational mathematical basis for the categorization of seizure exacerbation as catamenial epilepsy has been developed. It identifies approximately one third of women as having catamenial epilepsy. If seizures show hormonal sensitivity in their occurrence, they may also respond to hormonal treatment. Successful open label trials using cyclic natural progesterone supplement, depomedroxyprogesterone and gonadotropin-releasing hormone analogues in women and using testosterone with or without aromatase inhibitor in men have been reported. Prospective, randomized, placebo-controlled, double-blind investigations are warranted and under way.

for many more studies go to:
(search for catamenial epilepsy, also do a search of AG Herzog, he is a specialist in this field.)

Maybe we should ask him here for a seminar, and Q&A time.
Catamenial Patterns -

Patterns and causes
Author: P Klein and AG Herzog

Catamenial (from the Greek kata, by; men, month) epilepsy refers to seizure exacerbation in relation to the menstrual cycle. Traditionally, the term has been used to refer to seizure exacerbation at the time of menstruation.

In its purest form, a woman with catamenial epilepsy may have seizures only at the time of menstruation, but this form is not very common. More typically, the woman may tend to have more seizures at particular times during her menstrual cycle, usually just before or during the onset of menstruation or at the time of ovulation.1-3
Patterns of catamenial epilepsy

Three patterns of catamenial seizure exacerbation may be observed:2
Catamenial Seizure Patterns

The three patterns of catamenial exacerbation of epilepsy in relation to serum estradiol (E2) and progesterone (P) levels. C1 = perimenstrual; C2 = preovulatory; C3 = luteal phase.


* perimenstrual
* at the time of ovulation
* throughout the second half of the menstrual cycle

Seizure exacerbation around the time of menstruation or ovulation occurs in women with normal menstrual cycles.

Women with abnormal menstrual cycles may have exacerbation in the second half (luteal phase) of the cycle. This pattern is the most difficult one to distinguish because the time of seizure exacerbation is prolonged rather than focused. These women have anovulatory cycles and inadequate luteal phase syndrome.4 Because they do not ovulate, no corpus luteum (derived from the egg leaving the ovary) is formed during the second (luteal) half of the menstrual cycle and no progesterone is secreted.

Causes of catamenial epilepsy

Menstrually related hormonal fluctuations in estrogen and progesterone underlie the patterns of catamenial seizure exacerbation. Estrogens facilitate seizures, whereas progesterone protects against seizures. During the menstrual cycle, serum levels of estradiol and progesterone fluctuate.

Estrogens (in particular estradiol, the most important of the different estrogen forms) have potent proconvulsant properties. They exert an excitatory effect on neurons by stimulating the N-methyl-D-aspartate (NMDA)- type glutamate receptor.5 In women with epilepsy, intravenous administration of conjugated estrogens activates epileptiform discharges and may result in seizures.6

Progesterone hyperpolarizes neurons, acting via one of its natural endogenous metabolites, allopregnanolone, as an agonist at the γ- aminobutyric acid (GABA)-a receptor with a potency almost a thousandfold greater than that of pentobarbital and greater than the most potent benzodiazepine, nitroflurazepam.7,8 In women with partial seizures, intravenous infusion of progesterone, resulting in luteal phase plasma levels, suppresses interictal epileptiform discharges.9

In a normally menstruating woman, the surge of serum estrogen levels at the time of ovulation may be associated with increased seizure tendency; as may the fall in serum progesterone levels just before and during menstruation.

In a woman with an anovulatory cycle, estrogen levels rise at the end of the follicular phase and stay elevated throughout the luteal phase until premenstrually, as in normally menstruating women. Little or no progesterone is secreted, however, creating an estrogen: progesterone (E/P) imbalance with a relative excess of estrogen (or deficiency of progesterone) throughout the whole second (luteal) half of the menstrual cycle. Seizure exacerbation results.10

A number of studies have suggested that both progesterone deficiency and estrogen excess relative to progesterone contribute to the catamenial pattern of seizure exacerbation in both normal women and in women with menstrual irregularities.1,2,10 The E/P ratio appears to determine the overall reproductive hormonal effect upon seizure frequency.10

In addition, premenstrual exacerbation of seizures may also be related to a decline in anticonvulsant medication levels.11,12 In women with catamenial epilepsy, phenytoin levels decline premenstrually by up to one-third.11,12 This decline may be due to an increased rate of clearance at the beginning of menstruation, with an associated reduction in the half-life of phenytoin from 19 to 13 hours.11 Hepatic microsomal enzymes metabolize both gonadal steroids and anticonvulsants such as phenytoin, with competition between the two. The premenstrual decline in gonadal steroid secretion may therefore permit increased metabolism of AEDs, resulting in lower serum levels.11 It is not certain whether all AEDs are affected. Phenobarbital is not, and catamenial fluctuation in serum levels of other AEDs has not been studied.

Adapted from: Klein P and Herzog AG. Endocrine aspects of partial seizures. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 207-232.
With permission from Elsevier (
Reviewed and revised February 2004 by Cynthia Harden, MD, Weill Cornell Medical College.
I also take water pills a week before my period because I retain the wrong kind of water in my brain. My epileptologist has offered to monitor me during my menses because of myoclonic seizure frequency, grand mals, depression. Ever since I was in a coma . Fluid on the brain. Losing fluid and blood.
Thanks so much for the info on catemenial epilepsy. Now I know I'm not going crazy and can speak to my neurologist with more confidence.
My Docs have offered time after time to monitor me during my menses. I just have been to busy. But my body is changing. So maybe I will. Teresa
Boy I would take them up on this.
So many medical abstracts mention in the conclusion that there needs to be more research done in this area.
Just think if all the women are "too busy" we might never get any answers. It just might be something very simple to fix.
Stacy I have really strong menstrual cycles too Heavy bleeding so much that im weak I feel like im going to die bad cramps, just want to sleep extreamly emotional mine last about 7 days also & before i start im moody I also have seizures most are with in the first three to four days before my ms.... .. ITS my two weeks of hell...I have really BAD pms too... my poor family.....

thanks you guys for the info about catemenial epilepsy before i lost my ins and money to pay my neuro he was actually leaning toward seizures around my ms... he wanted to do more test around my monthly. I just ran out of money... now that ive been referred to this free clinic its sliding scale fee & they can work with my neurologist maybe we can get to the bottom of all this......
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