Source: DGNews  |  Posted 2 years ago

By John Otrompke

BOSTON -- December 10, 2009 -- A number of characteristics may make some women
who suffer from epilepsy more prone to premenstrual dysphoric disorder (PMDD),
according to a research presented here at the American Epilepsy Society (AES)
63rd Annual Meeting.

Risk factors include the affected region of the brain and carbamazepine usage,
while certain hormonal ratios and use of lamotrigine were inversely related to
premenstrual depression.

“Premenstrual dysphoric disorder is found in about 7% of healthy women, but in
women with epilepsy, the number can be as high as 20%,” explained lead author
Sarah D. Smithson, Beth Israel Deaconess Medical Center, Boston, Massachusetts,
speaking here at a poster presentation on December 5.

The study was a prospective analysis of 43 women with epilepsy who completed
the Endicott Daily Record of Severity of Problems to designate PMDD. The
questionnaire was completed by the women every day for 2 complete menstrual
cycles. Of the patients, 14 were on carbamazepine, 20 on lamotrigine, 8 on
levetiracetam, and 1 on topiramate; the researchers also examined 16 normal
control subjects.

“The questionnaire first asked 4 specific questions about mood -- such as
anxiety or depression, food cravings, changes in sleep, or cramps,” Smithson
said, noting that the questionnaire also asked about physical symptoms. “We
also did a blood draw during days 20 through 24 of the menstrual cycle to look
at hormonal levels,” she explained.

“None of the patients met all of the criteria for PMDD, including for
functional impairment, such as avoidance of social activity -- if they avoided
working or social gatherings, or couldn’t function normally,” Smithson said.
Seven women, however, met the less-strict threshold of 6 of 8 criteria over 2
cycles.

The study did find that PMDD had a stronger association with epilepsy on the
right rather than the left side of the brain.

“We also looked at oestradiol and progesterone, a neuroinhibitor associated
with mood stability, and found a low oestradiol-to-progesterone ratio was
associated lower rates of PMDD,” noted Smithson. “In addition, we found that
women who had really low levels of PMDD had high levels of lamotrigine, but
where carbamazepine levels were high mid-luteally, so were levels of PMDD,” she
added.

There was no significant difference between women with primary generalised
epilepsy and partial-onset seizures, nor was there a correlation with age of
seizure onset, or length or frequency of seizures, according to the abstract.

Funding for this study was provided by GlaxoSmithKline.

Presentation title: Premenstrual Dysphoric Disorder in Women With
Epilepsy: Relationships to Epileptic, Antiepileptic Drug and Reproductive
Endocrine Features. Abstract 1.089