The menstrual-epilepsy nexus: exploring the relationship between menstrual cycle and epileptic seizures in women

Background. The term “catamenial epilepsy” (CE) describes a pattern of seizures that worsen during specific menstrual cycle phases, with hormonal fluctuations, particularly in progesterone and estrogen, believed to affect neuronal excitability. CE presents a significant challenge for women with epilepsy, as it can complicate treatment and increase seizure frequency. The precise mechanisms behind this hormonal influence on seizure activity remain unclear. Understanding how different menstrual stages impact seizure patterns is critical for improving treatment strategies and quality of life for women with epilepsy. The study aimed to assess the connection between seizure activity in women with epilepsy and menstrual cycle phases, investigating associations between specific phases and seizure frequency. It also sought to determine the prevalence of drug-resistant epilepsy (DRE) in women with catamenial epilepsy (CE) and examine whether CE is more strongly associated with treatment resistance compared to women without cyclical changes. Methods. This systematic review aimed to determine the prevalence of drug-resistant epilepsy (DRE) in women with CE, explore hormonal mechanisms, and assess the relationship between seizure activity and menstrual cycle phases. A comprehensive search of Google Scholar, Cochrane Library, and PubMed identified 1,245 articles, with 45 meeting the inclusion criteria. Results. The findings revealed significant differences in seizure frequency between menstrual phases. The follicular phase had the highest seizure frequency (24%), while the menstrual phase had the lowest (4%) (OR 3.78, 95% CI 2.45–5.82, p < 0.001). Women with CE were nearly four times more likely to have DRE than women without cyclical seizure patterns. Conclusions. The study highlights the need for individualized treatment plans that consider hormonal influences on seizure patterns. Further research into the mechanisms of CE and its impact on treatment strategies is necessary. Integrating hormonal effects into treatment options for women with cyclical seizure fluctuations could improve outcomes.