Abstracts

RATIONALE: Progesterone has been demonstrated to have protective effects against seizures that occur in a catamenial pattern. Due to the variable absorption of natural progesterone, we tested low dose daily oral micronized progesterone (Prometrium) to determine whether this formulation of natural progesterone could be as effective clinically as higher daily doses of non-micronized progesterone therapy reported by others.
METHODS: Seventeen women with pharmaco-resistant complex partial seizures occuring in a catamenial pattern (periovulatory: days 10 to -13; perimenstrual: days -3 to 3; luteal phase: days 10 to 3) were enrolled in an open label treatment protocol. Patients were required to have 2 or more seizures in a 3 month period prior to receiving Prometrium 100 mg bid during days 15 through 2 of their menstrual cycle while maintaining optimized AED dosing.
RESULTS: Seventeen patients were enrolled in the study but 6 did not complete it. Of these 6 patients, 3 decided not to begin use of Prometrium, and 3 did not complete the open label phase because of side effects of the Prometrium or the need to adjust their AED dosing. Eleven patients completed a seizure diary for six menstrual cycles (3 cycles pretreatment phase, 3 cycles open label treatment phase). Mean age was 35.6 years. Eight patients (72.7%) reported a reduction in seizure frequency (mean 38.9%) during the treatment phase compared to baseline. One patient reported no change and 2 patients reported worsening of their seizures. Analysis of the catamenial patterns showed that 8 of 11 patients had seizures perimenstrually, 8 out of 11 had seizures during the luteal phase, and 7 out of 11 had seizures in the periovulatory phase. Four of the 8 patients (50%) with perimenstrual seizures reported improvement in seizure frequency, 1 reported no change, and 3 worsened. Seven of the 8 patients (87.5%) with luteal phase seizures improved and 1 worsened. Five of the 7 patients (71.4%) with periovulatory seizures improved and 2 worsened.
CONCLUSIONS: Preliminary results suggest that the use of Prometrium 100 mg bid in the treatment of women with catamenial epilepsy may improve seizure control for some patients, but may be too low of a dose for others. The best response to Prometrium was noted in patients who had seizures occurring across all three catamenial patterns. Analysis based on individual catamenial patterns suggested that patients with luteal phase seizures and periovulatory seizures had a better response to treatment than patients with perimenstrual seizures.
Support: Auxilliary of Allegheny General Hospital