PREMATURE OVARIAN FAILURE OCCURS FREQUENTLY IN
WOMEN WITH EPILEPSY. Premature ovarian failure—menopause by age 40 years—occurs at a markedly
higher rate in women with epilepsy (4.8%) than in
women in the general population (1%), reported Teresa
A. Tran, MD, adjunct associate professor of neurology
at the University of Minnesota, Minneapolis.
Tran’s team surveyed the menstrual history and
menopause symptoms of all women aged 40 to 60
years at their clinic since 2002. Study exclusion criteria
included having nonepileptic events, current use of
hormone contraceptives, and surgical menopause.
Of the 269 patients in the study, medical records
were reviewed for age at seizure onset, epilepsy diagnosis,
seizure history, antiepileptic drug history, concomitant
medication history, endocrinologic disorders,
weight, and height. Patient menopause status
was self-reported and defined as not having a menstrual
period in 12 months or more.
Thirteen women (4.8%) were postmenopausal by
age 40 years (mean, 35.8 years; range, 25 to 40 years).
Of these patients, none had a known endocrinologic
disorder; 12 had localization-related epilepsy; age at
seizure onset ranged from younger than 1 year to 20
years (mean, 8.5 years; median, 5 years); and 9 were
experiencing at least 1 seizure per year (range, fewer
than 1 per month to 17 per month). According to Tran,
these results raise concerns that poorly controlled
epilepsy disrupts the hypothalamic-pituitary-ovarian
axis and reproductive function.
SEIZURE CLUSTERS OCCUR OFTEN IN WOMEN WITH
ANOVULATORY CYCLES. The majority (53.3%) of women
with localization-related epilepsy have clustered
seizure distributions, and clustering may be significantly
more common with anovulatory than with ovulatory
cycles, according to the preliminary findings of
a prospective study presented by Kristen M. Fowler,
MA, study coordinator at the Beth Israel Deaconess
Medical Center, Harvard Neuroendocrine Unit, Boston,
and colleagues. According to the authors, previous
studies have shown that seizures in women may
not occur randomly but may cluster.
The research team collected data on 100 women
aged 13 to 45 years with localization-related epilepsy
who were participating in a multicenter investigation
of supplemental progesterone therapy for the treatment
of intractable seizures. Data were recorded on
seizures and menses during 3 baseline menstrual cycles.
Midluteal progesterone levels of 5 ng/mL or
higher were used to identify ovulatory cycles.
Seventy-five patients (75%) had 10 or more seizures
during the 3-month observation period. Of these, 29
(38.7%) had random seizure distributions. Of the 46
(61.3%) patients who had nonrandom distributions, 6
(13.0%) had even distributions, and 40 (87.0%) had
clustered distributions. Researchers reported that clustering
was significant in those patients with anovulatory
cycles compared with those with ovulatory cycles.
There was no evidence of clustering related to age
of study participants, age of participants at epilepsy
onset, duration of epilepsy, EEG laterality, or antiepileptic
drug therapy.
