title: Variation of seizure frequency with ovulatory status of menstrual cycles.
abstract: OBJECTIVE
  To determine if seizure frequency differs between anovulatory and ovulatory cycles.
  
  
  METHODS
  The data came from the 3-month baseline phase of an investigation of progesterone therapy for intractable focal onset seizures. Of 462 women who enrolled, 281 completed the 3-month baseline phase and 92 had both anovulatory and ovulatory cycles during the baseline phase. Midluteal progesterone levels ≥5 ng/ml were used to designate cycles as ovulatory. Among the 92 women, average daily seizure frequency (ADSF) for all seizures combined and each type of seizure considered separately (secondary generalized tonic-clonic seizures - 2°GTCS, complex partial seizures - CPS, simple partial seizures - SPS) were compared between anovulatory and ovulatory cycles using paired t-tests. A relationship between the proportional differences in ADSF and estradiol/progesterone (EP) serum level ratios between anovulatory and ovulatory cycles was determined using bivariate correlational analysis.
  
  
  RESULTS
  ADSF was 29.5% greater for 2°GTCS during anovulatory than during ovulatory cycles. ADSF did not differ significantly for CPS or SPS or for all seizures combined. Proportional differences in anovulatory/ovulatory 2°GTCS ADSF ratios correlated significantly with differences in anovulatory/ovulatory EP ratios. Among the 281 women, the three seizure types did not differ in ovulatory rates, but EP ratios were greater for cycles with 2°GTCS than partial seizures only.
  
  
  CONCLUSIONS
  Seizure frequency is significantly greater for 2°GTCS, but not CPS or SPS, during anovulatory cycles than ovulatory cycles. Because the proportional increases in 2°GTCS frequency during anovulatory cycles correlate with the proportional increases in EP level ratios, these findings support a possible role for reproductive steroids in 2°GTCS occurrence.
authors.affiliation: Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. aherzog@bidmc.harvard.edu
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Herzog
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Fowler
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sperling
authors.forename: Joyce D
authors.initials: JD
authors.lastname: Liporace
authors.forename: Laura A
authors.initials: LA
authors.lastname: Kalayjian
authors.forename: Christianne N
authors.initials: CN
authors.lastname: Heck
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Krauss
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Dworetzky
authors.forename: Page B
authors.initials: PB
authors.lastname: Pennell
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000858:Anovulation / Q000503:physiopathology; D016009:Chi-Square Distribution; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000503:physiopathology; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000502:physiology*; D010060:Ovulation / Q000502:physiology*; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D012640:Seizures / Q000209:etiology / Q000503:physiopathology*
chemical_list: D011374:Progesterone