title: A case of recurrent status epilepticus and successful management with progesterone.
abstract: Catamenial epilepsy (CE) is a commonly observed phenomenon among women with epilepsy, the management of which is both hormonal and non-hormonal. Progesterone therapy has been tried in these patients, as the possible mechanism of CE is withdrawal of progesterone and a higher oestrogen/progesterone ratio in the perimenstrual and periovulatory periods. Here, we describe a 24-year-old lady with multiple seizure types since childhood, which were refractory to adequate antiepileptic drug therapy after menarche with catamenial clustering of seizures. She went on to have several episodes of non-convulsive status epilepticus also with similar periodicity, which would abate only with midazolam infusion, without the need for ventilatory support. She was tried on acetazolamide, progesterone vaginal pessaries, and maximum tolerated doses of antiepileptic medications, but finally responded to intramuscular and oral progesterone, and has been seizure-free for more than a year.
authors: All India Institute of Medical Sciences, New Delhi, India.
authors: Bhargavi
authors: B
authors: Ramanujam
authors: All India Institute of Medical Sciences, New Delhi, India.
authors: Amit
authors: A
authors: Arora
authors: All India Institute of Medical Sciences, New Delhi, India.
authors: Varun
authors: V
authors: Malhotra
authors: All India Institute of Medical Sciences, New Delhi, India.
authors: Deepa
authors: D
authors: Dash
authors: All India Institute of Medical Sciences, New Delhi, India.
authors: Santosh
authors: S
authors: Mehta
authors: All India Institute of Medical Sciences, New Delhi, India.
authors: Manjari
authors: M
authors: Tripathi
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000187:drug effects; D008874:Midazolam / Q000627:therapeutic use; D011374:Progesterone / Q000627:therapeutic use*; D012640:Seizures / Q000175:diagnosis / Q000188:drug therapy*; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D011374:Progesterone; D008874:Midazolam
keywords: catamenial epilepsy; progesterone therapy; recurrent NCSE