Brisbane, Globally approximately 50 million people suffer from epilepsy. Half of these are women.
Until now, treatments for men and women have been the same. But men and women experience epilepsy differently.
For women, hormone fluctuations – from reproductive years to pregnancy, perimenopause, and menopause – can affect the frequency of seizures at many stages in their lives.
As we outlined in our recent paper, we need to take this into account and tailor women's treatments accordingly.What is epilepsy?
In people without epilepsy, the overall electrical activity of the brain is stable. Signals acting on neurons (brain cells) allow a fine balance to function between excitation (increased brain electrical activity) and inhibition (decreased brain electrical activity).
However, in epilepsy this balance is disturbed. When a burst of uncontrolled electrical activity occurs, some or all of the neurons are temporarily over-excited or in "overdrive." This causes a seizure (or seizures).This disruption can occur unexpectedly, somewhat like an earthquake, where the seizure comes on suddenly and then usually stops suddenly.
Epilepsy can seriously affect people's quality of life. People with epilepsy have an increased risk of premature death not only from epilepsy, but also from other complications of seizures and suicide.
What role do hormones play?
The hormones estrogen and progesterone are made in the ovaries and brain. Whether a woman has epilepsy or not, the levels of these hormones fluctuate throughout her life.But having epilepsy can also affect the production of estrogen and progesterone.
In general, estrogen signals more electrical activity and progesterone signals less. The ratio of these two hormones is important for a good balance of electrical activity in the brain.
But an unfavorable ratio disrupts the balance, causing fluctuations in symptoms.
Some specific anti-seizure medications can also alter this ratio by reducing estrogen and progesterone levels.Take the example of “catamenial epilepsy,” which one study shows affects about half of women with epilepsy.
In this type of epilepsy, women may have more seizures at certain times of the menstrual cycle. This usually happens just before their menstruation, when progesterone levels are falling and the ratio of estrogen and progesterone is changing. In other words, progesterone prevents seizures.
Another time of hormonal changes occurs around menopause.If a woman has catamenial epilepsy, this may lead to an increase in seizures during perimenopause, when both hormone levels are becoming irregular and menstruation is becoming irregular. But seizures decrease during menopause when levels of both hormones become steadily lower.
Researchers have long known about the cyclical nature of fluctuations in women's reproductive hormones and its impact on epilepsy. But that hasn't yet translated into how we treat women.
what should we do?
We urgently need research into how hormone fluctuations during different stages in a woman's life affect her epilepsy and quality of life.We need to better understand whether we can reduce the frequency of seizures with progesterone during certain times of the menstrual cycle. We also need to better understand whether estrogen (in menopause replacement therapy, also known as hormone replacement therapy or HRT) can make seizures worse in later life.
If we do not research the impact of hormonal fluctuations on epilepsy, we risk not treating the specific trigger of seizures that many women suffer from.
About 30 percent of women suffering from epilepsy do not respond to drug treatment. We don't know how much of this is due to hormonal factors.However, we know that seizures play a huge role in increasing the burden of this disease. And that burden can be improved by better treating seizures.(Conversation)
GSP
GSP
Until now, treatments for men and women have been the same. But men and women experience epilepsy differently.
For women, hormone fluctuations – from reproductive years to pregnancy, perimenopause, and menopause – can affect the frequency of seizures at many stages in their lives.
As we outlined in our recent paper, we need to take this into account and tailor women's treatments accordingly.What is epilepsy?
In people without epilepsy, the overall electrical activity of the brain is stable. Signals acting on neurons (brain cells) allow a fine balance to function between excitation (increased brain electrical activity) and inhibition (decreased brain electrical activity).
However, in epilepsy this balance is disturbed. When a burst of uncontrolled electrical activity occurs, some or all of the neurons are temporarily over-excited or in "overdrive." This causes a seizure (or seizures).This disruption can occur unexpectedly, somewhat like an earthquake, where the seizure comes on suddenly and then usually stops suddenly.
Epilepsy can seriously affect people's quality of life. People with epilepsy have an increased risk of premature death not only from epilepsy, but also from other complications of seizures and suicide.
What role do hormones play?
The hormones estrogen and progesterone are made in the ovaries and brain. Whether a woman has epilepsy or not, the levels of these hormones fluctuate throughout her life.But having epilepsy can also affect the production of estrogen and progesterone.
In general, estrogen signals more electrical activity and progesterone signals less. The ratio of these two hormones is important for a good balance of electrical activity in the brain.
But an unfavorable ratio disrupts the balance, causing fluctuations in symptoms.
Some specific anti-seizure medications can also alter this ratio by reducing estrogen and progesterone levels.Take the example of “catamenial epilepsy,” which one study shows affects about half of women with epilepsy.
In this type of epilepsy, women may have more seizures at certain times of the menstrual cycle. This usually happens just before their menstruation, when progesterone levels are falling and the ratio of estrogen and progesterone is changing. In other words, progesterone prevents seizures.
Another time of hormonal changes occurs around menopause.If a woman has catamenial epilepsy, this may lead to an increase in seizures during perimenopause, when both hormone levels are becoming irregular and menstruation is becoming irregular. But seizures decrease during menopause when levels of both hormones become steadily lower.
Researchers have long known about the cyclical nature of fluctuations in women's reproductive hormones and its impact on epilepsy. But that hasn't yet translated into how we treat women.
what should we do?
We urgently need research into how hormone fluctuations during different stages in a woman's life affect her epilepsy and quality of life.We need to better understand whether we can reduce the frequency of seizures with progesterone during certain times of the menstrual cycle. We also need to better understand whether estrogen (in menopause replacement therapy, also known as hormone replacement therapy or HRT) can make seizures worse in later life.
If we do not research the impact of hormonal fluctuations on epilepsy, we risk not treating the specific trigger of seizures that many women suffer from.
About 30 percent of women suffering from epilepsy do not respond to drug treatment. We don't know how much of this is due to hormonal factors.However, we know that seizures play a huge role in increasing the burden of this disease. And that burden can be improved by better treating seizures.(Conversation)
GSP
GSP
