Premenstrual Epilepsy and Natural Progesterone
Progesterone has been used to treat seizures that occur relative to the menstrual cycle. Catamenial seizures, also called catamenial epilepsy, occur in about one-third of all women with epilepsy. Women who have refractory complex partial seizures or generalized tonic clonic seizures are most likely to experience catamenial exacerbation, which occurs most commonly at the time of menstruation. Less often, catamenial seizures may arise at the time of ovulation or may last from ovulation to the beginning of menstruation.
In laboratory research, progesterone, in both its natural form and synthetically made (medroxyprogesterone), has strong antiseizure properties. The metabolites of natural progesterone have powerful effects on enhancing gamma-amino-butyric acid (GABA) activity in the brain. GABA is an inhibitory neurotransmitter and therefore increasing its activity would be expected to decrease the likelihood of seizures
Progesterone, when used in women with epilepsy to prevent seizures, must be considered a complementary and unproven treatment, used only in combination with standard antiseizure treatments. It does not appear to be a powerful-enough treatment to be used alone.
Further, it must be kept in mind that hormonal changes only influence seizure occurrence, and menstrual hormonal cycling is not the underlying cause of seizures. Whether using a hormone such as progesterone can prevent these hormonally-influenced seizures remains to be proven.
According to Cynthia L. Harden, MD, Associate Professor of Neurology and Neuroscience and Associate Attending in Neurology at the Weill Medical College of Cornell University in New York, NY., “progesterone is a potentially beneficial complementary treatment for seizure disorders in women who have seizure exacerbations in relationship to their menstrual cycles. Its exact benefit remains to be proven and is currently under evaluation. The neurologist and gynecologist should both be involved when progesterone is used for women with epilepsy.”
