Hormone replacement therapy in women with epilepsy: a randomized, double-blind, placebo-controlled study.
OBJECTIVE
Previous reports have suggested that hormone replacement therapy (HRT) could increase seizure activity in women with epilepsy. We sought to determine whether adding HRT to the medication regimen of postmenopausal women with epilepsy was associated with an increase in seizure frequency.


METHODS
This was a randomized, double-blind, placebo-controlled trial of the effect of HRT on seizure frequency in postmenopausal women with epilepsy, taking stable doses of antiepileptic drugs (AEDs), and within 10 years of their last menses. After a 3-month prospective baseline, subjects were randomized to placebo, Prempro (0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate or CEE/MPA) daily, or double-dose CEE/MPA daily for a 3-month treatment period.


RESULTS
Twenty-one subjects were randomized after completing baseline. The subjects' ages ranged from 45 to 62 years (mean, 53 years; SD, +/-5), and the number of AEDs used ranged from none to three (median, one). Five (71%) of seven subjects taking double-dose CEE/MPA had a worsening seizure frequency of at least one seizure type, compared with four (50%) of eight taking single-dose CEE/MPA and one (17%) of six taking placebo (p = 0.05). An increase in seizure frequency of the subject's most severe seizure type was associated with increasing CEE/MPA dose (p = 0.008). An increase in complex partial seizure frequency also was associated with increasing CEE/MPA dose (p = 0.05). Two subjects taking lamotrigine had a decrease in lamotrigine levels of 25-30% while taking CEE/MPA.


CONCLUSIONS
CEE/MPA is associated with a dose-related increase in seizure frequency in postmenopausal women with epilepsy. CEE/MPA may decrease lamotrigine levels.
Harden
Cynthia L
CL
Comprehensive Epilepsy Center, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY 10021, USA. clharden@med.cornell.edu
Herzog
Andrew G
AG
Nikolov
Blagovest G
BG
Koppel
Barbara S
BS
Christos
Paul J
PJ
Fowler
Kristen
K
Labar
Douglas R
DR
Hauser
W Allen
WA
D000927:Anticonvulsants / Q000097:blood / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D017029:Epilepsy, Complex Partial / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D015914:Estrogen Replacement Therapy / Q000379:methods*; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D008875:Middle Aged; D010919:Placebos; D017698:Postmenopause / Q000187:drug effects; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014227:Triazines / Q000097:blood / Q000627:therapeutic use
D000927:Anticonvulsants; D004338:Drug Combinations; D004966:Estrogens, Conjugated (USP); D010919:Placebos; C466383:Prempro; D014227:Triazines; D017258:Medroxyprogesterone Acetate; D000077213:Lamotrigine