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Cited by 167Epilepsy research and treatmentPharmacological Effects and Toxicity StudiesMenstrual Health and Disorders

The role of neurosteroids in the pathophysiology and treatment of catamenial epilepsy

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Reddy, Doodipala Samba·2009·Epilepsy Research
DOI 10.1016/j.eplepsyres.2009.02.017PMC PMC2696558
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Abstract

Catamenial epilepsy is a multifaceted neuroendocrine condition in which seizures are clustered around specific points in the menstrual cycle, most often around perimenstrual or periovulatory period. Generally, a twofold or greater increase in seizure frequency during a particular phase of the menstrual cycle could be considered as catamenial epilepsy. Based on this criteria, recent clinical studies indicate that catamenial epilepsy affects 31-60% of the women with epilepsy. Three types of catamenial seizures (perimenstrual, periovulatory and inadequate luteal) have been identified. However, there is no specific drug available today for catamenial epilepsy, which has not been successfully treated with conventional antiepileptic drugs. Elucidation of the pathophysiology of catamenial epilepsy is a prerequisite to develop specific targeted approaches for treatment or prevention of the disorder. Cyclical changes in the circulating levels of estrogens and progesterone play a central role in the development of catamenial epilepsy. There is emerging evidence that endogenous neurosteroids with anticonvulsant or proconvulsant effects could play a critical role in catamenial epilepsy. It is thought that perimenstrual catamenial epilepsy is associated with the withdrawal of anticonvulsant neurosteroids. Progesterone and other hormonal agents have been shown in limited trials to be moderately effective in catamenial epilepsy, but may cause endocrine side effects. Synthetic neurosteroids, which enhance the tonic GABA-A receptor function, might provide an effective approach for the catamenial epilepsy therapy without producing hormonal side effects.

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  • Catamenial epilepsy is characterized by perimenstrual seizure exacerbation, involving altered levels of anticonvulsant THDOC, proconvulsant DHEA-S and cortisol, and premenstrual allopregnanolone withdrawal.

    “In this context, one of the most investigated condition is catamenial epilepsy, characterized by perimenstrual seizure exacerbation, involving altered levels of anticonvulsant THDOC, proconvulsant DHEA-S and cortisol [146], and premenstrual allopregnanolone withdrawal [147].”

    From Fibromyalgia pathogenesis explained by a neuroendocrine multistable model (2024) · cites this paper as [147]

    The Definition and Patterns sections describe perimenstrual seizure exacerbation, and the Adrenal-derived neurosteroids section identifies THDOC as anticonvulsant and reports lower THDOC levels in women with catamenial epilepsy. That section calls DHEAS proconvulsant but explicitly says its levels did not change; it reports a lower DHEAS/cortisol ratio, not established alterations in the levels of both substances, and says cortisol’s role in catamenial exacerbation is unclear. The allopregnanolone-withdrawal clause is attached to a different citation [147]. Page numbers were not supplied in our copy. (LLM, conf=0.88)

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  • Clinical trials have been conducted with progesterone, the synthetic progestin norethisterone, and the gonadotropin antagonist goserelin.

    “while clinical trials have also been conducted with progesterone, the synthetic progestin norethisterone, and the gonadotropin antagonist goserelin [54,147].”

    From Fibromyalgia pathogenesis explained by a neuroendocrine multistable model (2024) · cites this paper as [147]

    The Hormonal therapy section (page unavailable) describes a progesterone trial and a study of norethisterone in nine women. It mentions goserelin as a GnRH analogue and cites work on its use in catamenial epilepsy, but does not establish that a clinical trial of goserelin was conducted or call it a gonadotropin antagonist. (LLM, conf=0.84)

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Authors
Reddy, D. S.
Affiliations
Texas A&M Health Science Center (US)
Corresponding author
Reddy, Doodipala Samba
ORCID
Reddy, Doodipala Samba
Venue
Epilepsy Research
Publisher
Elsevier BV
Published
2009-07
Volume
85
Issue
1
Pages
1-30
ISSN
0920-1211 (ISSN-L)
DOI
10.1016/j.eplepsyres.2009.02.017
PMC
PMC2696558
OpenAlex
W2020886601
Cited by
167
References
7
Citations by year
2026: 6 · 2025: 8 · 2024: 6 · 2023: 14 · 2022: 5 · 2021: 6 · 2020: 9 · 2019: 4 · 2018: 5 · 2017: 10 · 2016: 13 · 2015: 8 · 2014: 11 · 2013: 12 · 2012: 11
FWCI
2.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Epilepsy Research (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Neurological Disorders and Stroke (R01NS051398, NS051398, NS052158, R21NS052158)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
Keywords
catamenial epilepsy, neurosteroids, menstrual cycle, estrogen, progesterone, progesterone therapy, GABAA receptor, women with epilepsy, seizure pathophysiology
MeSH terms
Animals, Anticonvulsants, Endocrine System Diseases, Epilepsy, Female, Humans, Menstrual Cycle, Steroids, Receptors, GABA

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