Catamenial status epilepticus. A rare condition or an underdiagnosed event

Abstract

Introduction. Catamenial epilepsy (CE) is a phenomenon in which seizures are related to hormonal changes due to the menstrual cycle. Estrogen has proconvulsant assets, whilst Progesterone has anticonvulsant proof. Three varieties of catamenial seizures have been defined: 1) C1- the most typical pattern (perimenstrual), is linked with withdrawal from high progesterone levels, 2) C2- periovulatory, is linked with follicular phase of the menstrual cycle, with high estrogen levels and 3) C3- inadequate lutealphase, in which progesterone levels are under normal limits, seen in healthy controls. The incidence of catamenial status epilepticus (CSE) is unknown and is seldom mentioned. Aim of study. To review scientific information about CSE for practical and scientific purposes. Methods and materials. This paper provides a review of clinical cases using PubMed and Hindawi databases over ten years period. Key terms used in the are searching for: CSE, CE. Results. During the ten years, only four clinical cases were reported in which CSE due to CE was diagnosed. Two of them were presenting with recurrent episodes of CSE, which became seizure-free with Triptorelin treatment. Triptorelin is a gonadorelin analog, which causes amenorrhea by suppressing hormonal fluctuations. Another case in which Recurrent Catamenial Nonconvulsive Status Epilepticus (CNCSE) was presented in a 21-year-old woman. Around the first episode of CNCSE, she was diagnosed with Polycystic Ovary Syndrome, she used progesterone vaginal pessaries, with no effect on seizures. The patient received Norethisterone for six months, after this treatment episodes of CNCSE were no further reported. Menstrual cycle and seizure calendar are important in CE. This documentation and videoelectroencephalogram help the diagnosis. Conclusion. Recurrent CSE can also occur in CE. CSE is infrequently noted in the literature. This phenomenon and hormonal treatment should be considered in female patients.