Princeton University, Department of Molecular Biology, Princeton, NJ.
At the time of submission and acceptance in February, Dr. Tyson was affiliated with Kaiser Permanente Northern California, Department of Obstetrics and Gynecology. However, as of 8/31/2020 she is no longer affiliated with Kaiser Permanente. She is now affiliated with Department of Obstetrics and Gynecology at Stanford University School of Medicine.
Perm J. 2020 Dec;24:1-3. doi: 10.7812/TPP/19.145.
Catamenial epilepsy (CE) is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy. There is a paucity of literature addressing this condition from a clinical standpoint, and the literature that does exist is limited to the neurological community. This article reviews the diagnosis and management of CE for the non-neurologist. Women with CE have early touch points in their care with numerous health care providers before ever consulting with a specialist, including OB/GYNs, pediatricians, emergency department physicians, and family medicine providers. In addition, women affected by CE have seizures that are more recalcitrant to traditional epilepsy treatment regimens. To optimize management in patients affected by CE, menstrual physiology must be understood, individualized hormonal contraception treatment considered, and adjustments and interactions with antiepileptic drugs addressed.
CE is a unique subset of seizure disorders affected by menstrual fluctuations of progesterone and estrogen. The diagnosis of CE has been refined and clarified. There is an ever-increasing understanding of the importance and variety of options of hormonal contraception available to help manage CE. Furthermore, antiepileptic drugs and contraception can interact, so attention must be directed to optimizing both regimens to prevent uncontrolled seizures and pregnancy.
CE can be diagnosed with charting of menstrual cycles and seizure activity. Hormonal treatments that induce amenorrhea have been shown to reduce CE. Optimizing antiepileptic drug dosing and contraceptive methods also can minimize unplanned pregnancies in women affected by CE.
月经周期中激素波动会使月经性癫痫（Catamenial Epilepsy，CE）恶化。美国约有 170 万女性患有癫痫。CE 影响超过 40%的癫痫女性。从临床角度来看，关于这种疾病的文献很少，而且现有的文献仅限于神经病学领域。本文综述了非神经科医生对 CE 的诊断和管理。患有 CE 的女性在咨询专家之前，很早就与许多医疗保健提供者有接触，包括妇产科医生、儿科医生、急诊医生和家庭医学提供者。此外，受 CE 影响的女性的癫痫发作对传统癫痫治疗方案更具抗性。为了优化受 CE 影响的患者的管理，必须了解月经生理，考虑个体化的激素避孕治疗，并解决与抗癫痫药物的调整和相互作用。
CE 是一种受孕激素和雌激素月经波动影响的独特癫痫子集。CE 的诊断已经得到了改进和澄清。人们越来越了解可用的激素避孕方法的重要性和多样性，这些方法可以帮助管理 CE。此外，抗癫痫药物和避孕药可能会相互作用，因此必须注意优化这两种方案，以防止不受控制的癫痫发作和怀孕。
通过记录月经周期和癫痫发作活动可以诊断 CE。已证明诱导闭经的激素治疗可减少 CE。优化抗癫痫药物剂量和避孕方法也可以最大限度地减少受 CE 影响的女性意外怀孕。
