Seizure exacerbation associated with inhibition of progesterone metabolism.
The reduced progesterone metabolite tetrahydroprogesterone is a potent positive modulator of GABA(A) chloride conductance that exerts powerful neuroinhibitiory and anti-seizure effects in animal models. Cyclic natural progesterone use may lessen seizure frequency in women with catamenial seizure exacerbation. We report a case in which efficacy was eliminated during concomitant treatment with a reductase inhibitor. The observation suggests that a reduced metabolite, rather than progesterone itself, was responsible for improved seizure control.
Herzog
Andrew G
AG
Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Frye
Cheryl A
CA
D000328:Adult; D004791:Enzyme Inhibitors / Q000009:adverse effects; D005260:Female; D018120:Finasteride / Q000009:adverse effects; D006801:Humans; D008597:Menstrual Cycle / Q000378:metabolism; D011280:Pregnanolone / Q000378:metabolism; D011374:Progesterone / Q000037:antagonists & inhibitors* / Q000378:metabolism*; D012640:Seizures / Q000139:chemically induced / Q000188:drug therapy / Q000378:metabolism*; D018709:Statistics, Nonparametric
D004791:Enzyme Inhibitors; D011374:Progesterone; D018120:Finasteride; D011280:Pregnanolone