Progesterone Trial Study Group Members: Donald Schomer MD, Edward Bromfield MD, Barbara Dworetzky MD, Sonia Replansky BS, Cynthia L. Harden MD, Blagovast Nikolov MD, Alison Pack MD, Alison Randle BS, Barbara Jobst MD, Gregory Holmes MD, Emily Clough BS, Page Pennell MD, Melanee Newman RN, Gregory Krauss MD, Peter Kaplan MD, Faith Muigai RN, Teresa Tran MD, Sabina Gapany PharmD, Eva Andermann MD, Frederick Andermann MD, Suha Mercho MD, Joyce Liporace MD, Michael Sperling MD, Gwendolyn Taylor BS, Laura Kalayjian MD, Christianne Heck MD and Sandra Oviedo BS.
Circalunar and ultralunar periodicities in women with partial seizures
Article first published online: 7 FEB 2008
© 2008 International League Against Epilepsy
Volume 49, Issue 6, pages 1081–1085, June 2008
How to Cite
Quigg, M., Fowler, K. M., Herzog, A. G. and the NIH Progesterone Trial Study Group (2008), Circalunar and ultralunar periodicities in women with partial seizures. Epilepsia, 49: 1081–1085. doi: 10.1111/j.1528-1167.2008.01537.x
- Issue published online: 7 FEB 2008
- Article first published online: 7 FEB 2008
- Accepted January 6, 2008; Online Early publication February 11, 2008.
- Partial seizures;
- Catamenial epilepsy;
Purpose: Little consensus exists for the definition of catamenial epilepsy. Few studies have evaluated the periodicity of seizures to test the hypothesis that seizures in women have periodic patterns of occurrence independent of a priori hormonal considerations. In the present study, we determined seizure periodicity according to a “menstrual clock” provided by a common phase marker of the onset of menses.
Methods: Seizure and menstrual diaries of ∼3 months duration were obtained from women enrolled in a trial of hormonal therapy for localization-related epilepsy. Midluteal progesterone levels identified ovulatory (≥5 ng/ml, OC) from anovulatory cycles (AC). Individual cycles were normalized to a common phase and period (day 0 = menses onset, intervening days = 28 bins). Periodicity of combined data was estimated with cosinor-nonlinear least squares analysis. Best-fit rhythms were estimated with 95% confidence limits.
Results: 100 patients provided 3344 seizures within 293 cycles (77% OC, 20% AC, indeterminate 3%). OC seizures displayed a circalunar rhythm with peak phase of occurrence at onset of menses. AC seizures also featured a circalunar rhythm that peaked at menses onset but also had ultralunar rhythms of ∼14 and ∼9 days.
Discussion: Seizures in women with epilepsy occur in circalunar rhythms. OC and AC seizures differ in seizure timing with the latter occurring in ultralunar rhythms in addition to the predominant circalunar rhythm. This finding supports the existence of catamenial epilepsy and differences in patterns of seizure occurrence between OC and AC.