Authors :
Presenting Author: Zubia Iqbal, MD – Wayne state university
Deepti Zutshi, MD – Wayne State University School of Medicine
Rohit Marawar, MD – Wayne State University School of Medicine
Rationale:
Catamenial epilepsy (CE) is a seizure pattern characterized by a twofold increase of clustering or worsening of seizures thought to be secondary to the natural cyclic variation of estrogen and progesterone levels through the menstrual cycle.1 Estimates of the rate of CE is between 10-70% in people of childbearing potential.2 There are three subtypes of CE: perimenstrual C1, periovulatory C2, and inadequate luteal phase C3.
In addition to antiseizure medications, acetazolamide, hormonal treatment and benzodiazepines during predicted seizure days interval may be useful in the treatment of CE. Currently, two FDA-approved intranasal benzodiazepine therapies are indicated for aborting acute seizure clusters.3 In our case report, off-label use of scheduled intranasal diazepam has transformed predictable catamenial seizure clusters into near-seizure-free cycles indicating an effective primary-prevention strategy.
Methods:
A 20-year-old female patient with drug-resistant generalized epilepsy has three seizure types: absence, myoclonic, and GTCs. All her seizures had perimenstrual exacerbations, but the effect was most pronounced for absence seizures (Day 9 of menstrual cycle) and GTCs (Days 6 to 9 of menstrual cycle.)
The patient’s seizures were resistant to brivaracetam, lamotrigine, topiramate, cannabinoid at high doses and VNS at maximal settings. Intranasal midazolam for seizure clusters caused significant drowsiness. She had also failed pulsed clonazepam and acetazolamide for control of catamenial seizures.