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NEUROLOGY 2009;73:223-227
© 2009 American Academy of Neurology

Laterality and location influence catamenial seizure expression in women with partial epilepsy

M. Quigg, MD, MSc, S. D. Smithson, BA, K. M. Fowler, MA, T. Sursal, BA, A. G. Herzog, MD, MSc On behalf of the NIH Progesterone Trial Study Group*

From the Department of Neurology (M.Q.), University of Virginia, Charlottesville; Harvard Neuroendocrine Unit (S.D.S., K.M.F., T.S., A.G.H.), Beth Israel Deaconess Medical Center, Boston, MA.

Address correspondence and reprint requests to Dr. Mark Quigg, University of Virginia, Department of Neurology 394, Charlottesville, VA 22908 quigg{at}virginia.edu

Objective: The temporal distribution of seizures in women with localization-related epilepsy occurs periodically according to a model "clock" with the peak phase of occurrence corresponding to menstrual onset. The location and laterality of the epileptic lesion as well as patient age may affect periodicity.

Methods: Baseline data from seizure and menstrual diaries of ~3 months duration were obtained from 100 women enrolled in a trial of hormonal therapy for localization-related epilepsy. Durations of individual cycles were normalized to a common menstrual phase and period. Normalized data were then combined to create distributions evaluated by localization (lobar: temporal [TL], extratemporal [XL], multifocal [MF], unknown), lateralization (left, right, bilateral, unknown), and age. Distributions were evaluated with analysis of variance (ANOVA) and curve-fitted by nonlinear least squares cosinor analysis.

Results: A total of 71 patients had TL (left = 25, right = 29, bilateral = 17), 10 XL, 14 MF, and 5 unknown seizure foci. XL and MF seizures occurred randomly across the 28-day cycle. TL seizures (left = 875, right = 706) occurred nonrandomly (ANOVA p = 0.0003) and cyclically with peak occurrence near onset of menses ([value ± SD] peak = 1.6 ± 2.3 days, period = 27.0 days). Left-side TL seizures peaked cyclically at onset of menses (ANOVA p = 0.04, peak = 0.0 ± 3.0 days, period = 30 days); right-side TL seizures occurred randomly. Age did not have a cyclical effect. Women below the median age had a significantly higher seizure rate than those above the median age.

Conclusion: Circalunar rhythms of seizures in women, and therefore, possibly strategies of hormonal treatments of catamenial epilepsy, vary with the neuroanatomic substrate of the seizure focus.

Abbreviations: ANOVA = analysis of variance; HPG = hypothalamo-pituitary-gonadal; LH = luteinizing hormone; MF = multifocal; TL = temporal; XL = extratemporal.

*Members of the NIH Progesterone Trial Study Group are listed in the appendix.

Supported by National Institute of Neurological Disorders and Stroke NIH (NIH RO1 NS39466) and an NIH General Clinical Research Center grant (MO1RR01032).

Disclosure: Author disclosures are provided at the end of the article.

Received December 3, 2008. Accepted in final form April 6, 2009.






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