Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Paracelsus Medical University, A-5020 Salzburg, Austria.
Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Paracelsus Medical University, A-5020 Salzburg, Austria.
Seizure. 2023 Jul;109:52-59. doi: 10.1016/j.seizure.2023.05.004. Epub 2023 May 5.
Catamenial epilepsy (CE) is defined as an increase in seizure frequency during specific phases of the menstrual cycle in women with epilepsy. The treatment usually includes a combination of non-hormonal and hormonal therapies. This systematic review summarizes the available data on the efficacy of progesterone and its derivates to treat CE.
We performed a systematic search of the literature to identify studies reporting data on the use of progesterone and its derivatives (any type and dose) for the treatment of CE. The main outcome included the efficacy of progesterone and its derivatives on seizure frequency.
Nineteen articles (457 patients) were included; four were randomized controlled trials (two comparing progesterone vs placebo and two comparing norethisterone vs placebo). Progesterone was generally administered during the luteal phase (from day 15 to 25) or during perimenstrual exacerbations (from day 23 to 25), with an average dose of 10-30 mg/day to a maximum of 300 mg/day. The therapy, usually well tolerated, was ineffective in the randomized controlled trials; conversely, it was associated with an overall reduction in seizure frequency in case reports and uncontrolled studies.
Although data from uncontrolled studies suggest that hormone therapy with progesterone may be useful in the treatment of CE, its efficacy has not been demonstrated in controlled trials. The possible antiseizure effect of progesterone could be mediated by its active metabolite allopregnanolone, making the plasmatic measurement of these hormones mandatory to evaluate efficacy. Further randomized controlled trials should investigate the efficacy of progesterone and its derivatives, addressing these pharmacological issues.
月经性癫痫（CE）是指女性癫痫患者在月经周期特定阶段癫痫发作频率增加。治疗通常包括非激素和激素疗法的联合应用。本系统综述总结了孕激素及其衍生物治疗 CE 的疗效的现有数据。
我们对文献进行了系统检索，以确定报告孕激素及其衍生物（任何类型和剂量）用于治疗 CE 的疗效数据的研究。主要结局包括孕激素及其衍生物对癫痫发作频率的疗效。
共纳入 19 篇文章（457 例患者）；其中 4 项为随机对照试验（2 项比较孕激素与安慰剂，2 项比较去氧孕烯与安慰剂）。孕激素通常在黄体期（第 15 至 25 天）或经前期加重期（第 23 至 25 天）给药，平均剂量为 10-30mg/天，最大剂量为 300mg/天。这种治疗方法通常耐受性良好，但在随机对照试验中无效；相反，在病例报告和非对照研究中，它与总体癫痫发作频率降低有关。
尽管来自非对照研究的数据表明孕激素激素治疗可能对 CE 治疗有用，但在对照试验中尚未证明其疗效。孕激素的可能抗癫痫作用可能是由其活性代谢物孕烷醇酮介导的，因此必须测量这些激素的血浆水平以评估疗效。应进一步进行随机对照试验，以解决这些药理学问题，研究孕激素及其衍生物的疗效。
