Conference Coverage

Age of Seizure Onset Is Related to Menarche in Women With Epilepsy

More women with epilepsy have seizure onset during the year of menarche than during any other year.


WASHINGTON, DC—Age of seizure onset is significantly associated with age of menarche, according to research presented at the 71st Annual Meeting of the American Epilepsy Society. Seizure onset, however, is also common in the years before and after menarche, suggesting an impact of increased production of neuroactive steroids.

“The levels of some hormones in the blood increase tenfold during this time of life, including neuroactive steroids that affect the brain and make a seizure more likely,” said Andrew G. Herzog, MD, Professor of Neurology at Harvard Medical School and Director of the Harvard Neuroendocrine Unit of Beth Israel Deaconess Medical Center in Boston. “Clearly more seizures develop in girls during that period of time, so we need to begin looking at risk factors as well as potential treatments.”

Andrew G. Herzog, MD

Previous research has suggested that seizure onset during late childhood may be related to menarche, but study results regarding this relationship have been inconsistent, said Dr. Herzog. To further examine the relationship between seizure onset and age of menarche, Dr. Herzog and colleagues analyzed data from an Epilepsy Birth Control Registry web-based survey of 1,144 women with epilepsy. The women were ages 18 to 47 and provided demographic, epilepsy, antiepileptic drug, reproductive, and contraceptive data.

The average age of menarche was 12.55, which was similar to that for women in the general population. Mean age of menarche was significantly greater in women with epilepsy who had seizure onset before menarche versus after menarche (12.70 vs 12.42). The average age of seizure onset was 14.13.

Overall, more women with epilepsy had seizure onset during the year of menarche than during any other year, significantly more than would have been expected by chance. Approximately 49% of seizure onset occurred over the span of two years before menarche and six years after menarche.

Girls who may be at risk of developing seizures (eg, those who have had febrile seizures or a head injury) may warrant closer monitoring and potential treatment with steroids or other medications to inhibit neuroactivity that may cause seizures, Dr. Herzog said.

“We need to look at the whole puberty process and this massive increase in hormone production,” said Dr. Herzog. “If we have a better idea of how hormones are acting on the brain, we can develop appropriate treatment.”

—Erica Tricarico

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