Catamenial Epilepsy: A Bizarre phenomenon!

Although a specific definition is still lacking, the consensus seems to be that the increase in seizure frequency (at least twice the baseline) during specific phase of menstrual cycle of the female, is highly suspicious of a diagnosis of Catamenial epilepsy. Atleast 33% of females with medically refractory seizures in their reproductive age group have this underlying condition. Women with partial epilepsy are more prone to have catamenial epilepsy, however other epilepsy syndromes associated with catamenial epilepsy is also well known. The perimenstrual followed by periovulatory phases are the phases where the patient is susceptible to have clustering of seizures as a part of catamenial epilepsy. The low progesterone to estrogen ratio is a commonly observed biochemical finding  during these times. Menopause is associated with drastic decrease in the frequency of catamenial epilepsy frequency. However, Acetazolamide,clobazam,hormonal therapy,GnRH analogues along with intermittent modification in the schedule of anti-epileptic medication( based on times of month when patient is most prone to have seizures) are some of the treatment options.