Breakouts, Bloating, Cramps, and…Seizures?
Creator: Kiwis | Credit: Getty Images/iStockphoto
For those of you who have had a period, do you remember what your first one was like? For many teens it’s an uncomfortable introduction to adolescence marked by debilitating cramps, insatiable cravings, and awkward conversations with parents. Let’s follow Daisy, a 12-year-old girl who is about to have this life-changing experience. But there’s a catch: Daisy is among the 1 in 200 school-age children with epilepsy, a disease characterized by bursts of abnormal and excessive brain activity called seizures (Aaberg et al., 2017).
When Daisy started middle school, she was a straight-A student. Teachers often remarked that she was “a pleasure to have in class.” But, in 7th grade, her grades began slipping and her teachers said that she was often “spaced out” or “daydreaming” in class. While her teachers and parents thought this marked the beginning of a rebellious phase, the real culprit was a series of absence seizures, a type of seizure common in children often mistaken for daydreaming. Thankfully, Daisy’s parents realized something was wrong and took her to a neurologist who diagnosed her with epilepsy. This diagnosis came with a prescription for Keppra®, an anti-seizure medication that allowed her to live seizure-free.
As Daisy entered 8th grade, she began to hear about her friends having their first periods. Some would comment about their cramps and others about their common breakouts, but, for Daisy, her first period would be preceded by something much more sinister: the first seizure she’d had since starting Keppra®.
The menstrual cycle is split into four phases:
menstrual phase: when a person has their period.
follicular phase: when their ovary is preparing to release an egg.
ovulatory phase: when the egg is released.
luteal phase: the time from release of the egg to the start of the next menstrual phase.
For people like Daisy with epilepsy, the fluctuating levels of steroid hormones (like estrogen and progesterone) in the brain during this cycle can have catastrophic effects. Epilepsy occurs when the forces that activate or deactivate our brain cells are imbalanced. Anything that shifts the balance in favor of increased activity can cause epilepsy. One of these forces is estrogen. Researchers have found that increased levels of estrogen can elevate levels of a chemical that activates brain cells, called glutamate. On the other hand, progesterone can increase the effect of a chemical that deactivates brain cells, called GABA.
Because estrogen and progesterone peak at different times during the menstrual cycle, there are times when they can become imbalanced leading to an imbalance in activation and deactivation of brain cells and thus seizures and epilepsy. Just 2 weeks before her first period, Daisy’s estrogen levels spiked during the ovulatory phase, causing increased brain cell activity. Despite her continued use of Keppra®, this spike in activity caused Daisy to have a seizure and led to her being diagnosed with catamenial epilepsy, or menstruation related epilepsy. Thankfully, Daisy’s neurologist prescribed a new antiseizure medication, acetazolamide, in addition to her Keppra®, which kept her seizures in check.
While Daisy might not be a real person, approximately 42% of people with epilepsy who menstruate can relate to her story (Herzog et al., 1997). Unfortunately, not all of them are able to control their seizures with medicine. For some, no combination of anti-seizure medications or drugs controlling hormonal levels can stop the seizures associated with their menstrual cycle. This is why continued research on catamenial epilepsy and the development of new medications for its treatment is vital.
References:
Aaberg KM, Gunnes N, Bakken IJ, Lund Søraas C, Berntsen A, Magnus P, Lossius MI, Stoltenberg C, Chin R, Surén P. Incidence and Prevalence of Childhood Epilepsy: A Nationwide Cohort Study. Pediatrics. 2017 May;139(5):e20163908. doi: 10.1542/peds.2016-3908. Epub 2017 Apr 5. PMID: 28557750.
Herzog AG, Friedman MN. Menstrual cycle interval and ovulation in women with localization‐related epilepsy. Neurology 2001;57(11):2133–5. [DOI: 10.1212/wnl.57.11.2133; PUBMED: 11739844]
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