Resumen
La epilepsia catamenial se define como la presencia o el incremento de crisis epilépticas, durante o inmediatamente antes de la menstruación. Su incidencia es variable dado el subregistro de pacientes. Se describen tres patrones: perimenstrual, ovulatoria y luteal, de acuerdo con la etapa del ciclo menstrual en que aparecen. Existen diferentes teorías sobre su fisiopatología: influencia hormonal (efecto proconvulsivante de los estrógenos y anticonvulsivante de la progesterona); posibles alteraciones hidroelectrolíticas, y cambios en la farmacocinética y farmacodinamia de los anticonvulsivantes.
Para su diagnóstico se requiere de la presencia de crisis, la caracterización del ciclo menstrual, su duración, niveles de progesterona y biopsia endometrial acorde a la etapa del ciclo. Dentro de las propuestas terapéuticas se encuentran el uso de acetazolamida, ajuste de anticonvulsivantes, adición de benzodiacepinas y terapia hormonal, aunque con los estudios actuales aún no hay suficientes criterios para validar la evidencia.
Citas
Foldvary N, Falcone T. Catamenial epilepsy. Pathophysiology, diagnosis, and management. Neurology 2003; 61: S2-S15.
Duncan JS, Shorvon SD, Fish DR. Clinical Epilepsy, New York: Churchill Livingstone; 1995.
Engel J. A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: Report of the ILAE Task Force on classification and terminology. Epilepsia 2001; 42: 1-8.
Karlow V, Vlasic P. New aspects of the catamenial epileptic seizures. Epilepsia 1995; 36: 193. Abstract.
Duncan S, Read C, Brodic M. How common is catamenial epilepsy? Epilepsia 1993; 34: 827-831.
Herzog A, Klein P, Ransil P. Three patterms of catamenial epilepsy. Epilepsia 1997; 38: 1082-1088.
Mattson R, Kamer J, Cramer A, Caldwell B. Seizure frecuency and the menstruak cycle: a clinical study. Epilepsia 1981; 22: 242.
Herzog A, Friedman M. Menstrual cycle interval and ovulation in women with localization-related epilepsy. Neurology 2001; 57: 2133-2135.
Smith M, Keel C, Greenberg, B, Adams L, Schmidt P, Rubinow A, Wassermann E. Menstrual cycle effects on cortical excitability. Neurology 1999; 53: 2069-2072.
Mcewen B. Clinical Review: 108 The Molecular and Neuroanatomical Basis for Estrogen Effects in the Central Nervous System. J Clin Endocrinol Metab 1999; 84.
Hom AC, Buterbaugh GG. Estrogen alters the acquisition of seizures kindled by repeated amygdala stimulation or pentylenetetrazol administration in ovariectomized female rats. Epilepsia 1986; 27: 103-108.
Nicoletti F, Speciale C, Sortino MA, et al. Comparative effects of estradiol benzoate, the antiestroge clomiphene citrate, and the progestin medroxyprogesterone acetate on kainic acid-induced seizures in male and female rats. Epilepsia 1985; 26: 252-257.
Van Luijtelaar G, Budziszewska B, Jaworska- Feil L, Ellis J, Coenen A, Lason W. The ovarian hormones and absence epilepsy: a long-term EEG study and pharmacological effects in a genetic absence epilepsy model. Epilepsy Res 2001; 46: 225-239.
Reddy DS, Kim HY, Rogawski MA. Neurosteroid withdrawal model of perimenstrual catamenial epilepsy. Epilepsia 2001; 42: 328-336.
Reddy DS, Rogawski MA. Enhanced anticonvulsant activity of neuroactive steroids in a rat model of catamenial epilepsy. Epilepsia 2001; 42: 337-344.
Millar JA, Neill KG. Captopril as adjunctive treatment in catamenial epilepsy. NZ Med J 1991; 28: 368-369. Abstract.
Shavit G, Lerman P, Korczyn AD, Kivity S, Bechar M, Gitter S. Phenytoin pharmacokinetics in catamenial epilepsy. Neurology 1984; 34: 959-961.
Kumar N, Behari M, Ahuja GK, Jailkhani BL. Phenytoin levels in catamenial epilepsy. Epilepsia 1988; 29: 155-158.
Cummings LN, Giudice L, Morrell MJ. Ovulatory function in epilepsy. Epilepsia 1995; 36: 355-359.
Herzog AG. Intermittent progesterone therapy of partial complex sei-zures in women with menstrual disorders. Neurology 1986; 36: 1607-1610.
Lim LL, Foldvary N, Mascha E, Lee J. Acetazolamide in women with catamenial epilepsy. Epilepsia 2001; 42: 746-749.
Feely M, Calvert R, Gibson J. Clobazam in catamenial epilepsy: a model for evaluating anticonvulsants. Lancet 1982; 2: 71-73. Abstract.
Karkuzhali B, Schomer DL. Weekly fluctuation and adjustment of antiepileptic drugs to treat catamenial seizures. Epilepsia 1998; 39(Suppl 6): 179. Abstract.
Dana-Haeri J, Richens A. Effect of norethisterone on seizures associated with menstruation. Epilepsia 1983; 24: 377-381.
Mattson RH, Cramer JA, Caldwell BV, Siconolfi BC. Treatment of seizures with medroxyprogesterone acetate: preliminary report. Neurology 1984; 34: 1255-1258. Abstract.
Herzog AG. Progesterone therapy in women with complex partial and secondary generalized seizures. Neurology 1995; 45: 1660-1662.
Herzog AG. Clomiphene therapy in epileptic women with menstrual disorders. Neurology 1988; 38: 432-434.
Millichap JG, Woodbury DM, Goodman BS. Mechanism of the Ichida M, Gomi A, Hiranouchi N, et al. A case of cerebral endometriosis causing catamenial epilepsy. Neurology 1993; 43: 2708-2709.
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