Moscol G, Espino P H, Mayor L C, Burneo J G
Schulich School of Medicine and Dentistry. Western University, London, Ontario, Canadá.
Hospital Universitario Fundación Santa Fe, Santa Fe de Bogotá, Colombia.
Rev Neurol. 2022 May 1;74(9):303-311. doi: 10.33588/rn.7409.2022041.
Catamenial pattern epilepsy is defined as an increase in the frequency of seizures during a specific stage of the menstrual cycle compared to baseline. It has been described that around a third of women with epilepsy have a catamenial pattern. The changes in the seizure pattern would be explained by the influence of catamenial fluctuations, of female gonadal hormones on neuronal excitability. Progesterone through its metabolite allopregnanolone plays a protective role by increasing GABAergic transmission; however, its effect on brain progesterone receptors can increase neuronal excitability. The effects of estrogens are complex, they tend to increase neuronal excitability, although their effects depend on their concentration and exposure time. Three catamenial patterns of seizure exacerbation have been proposed: the perimenstrual pattern, the periovulatory pattern, and the luteal pattern. The diagnostic approach is carried out through a systematic process of 4 steps: a) clinical history of the pattern of the menstrual cycle and epileptic seizures; b) diagnostic methods to characterize the menstrual cycle and the pattern of seizures; c) check diagnostic criteria; and d) categorize the catamenial pattern. The treatment options studied require a higher level of evidence, and there is no specific treatment. Optimization of conventional antiseizure treatment is recommended as the first therapeutic option. Other therapeutic options, such as non-hormonal and hormonal treatments, could be useful in case the first therapeutic option proves to be ineffective.
经期型癫痫被定义为与基线相比，在月经周期的特定阶段癫痫发作频率增加。据描述，约三分之一的癫痫女性有经期型发作模式。癫痫发作模式的变化可由经期波动、女性性腺激素对神经元兴奋性的影响来解释。孕酮通过其代谢产物别孕烯醇酮通过增加GABA能传递发挥保护作用；然而，其对脑孕酮受体的作用可增加神经元兴奋性。雌激素的作用较为复杂，它们往往会增加神经元兴奋性，尽管其作用取决于浓度和暴露时间。已提出三种癫痫发作加重的经期模式：经前期模式、排卵期模式和黄体期模式。诊断方法通过4个步骤的系统流程进行：a）月经周期和癫痫发作模式的临床病史；b）表征月经周期和癫痫发作模式的诊断方法；c）检查诊断标准；d）对经期模式进行分类。所研究的治疗选择需要更高水平的证据，且尚无特异性治疗方法。建议将优化传统抗癫痫治疗作为首要治疗选择。如果首要治疗选择被证明无效，其他治疗选择，如非激素和激素治疗，可能会有用。
