How can menstruation trigger seizures in a 22-year-old?

Question

Hello doctor,

I am seeking your guidance concerning a recent health event experienced by my 22-year-old friend. She had her first seizure three days ago, which coincided with the onset of her menstrual period. Historically, she has endured severe menstrual cramps and heavy bleeding, but this cycle was notably more intense. Following the seizure, she experienced significant confusion and a severe headache.

She has been on oral contraceptive pills for approximately a year, and we are contemplating whether hormonal fluctuations or the medication might have contributed to this incident. Specifically, we are curious to understand:

Can severe menstrual pain or hormonal disturbances trigger seizures?
Is there a possibility of this occurring again in future cycles?
Should we be concerned about the recurrence of such episodes?

Your expertise and advice on this matter would be greatly appreciated.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Your explanation about the potential link between hormonal fluctuations and seizure (electrical activity in the brain that can cause changes in behavior, movements, feelings, or levels of consciousness) activity, particularly in the context of catamenial epilepsy (seizure frequency intensifies during phases of the menstrual cycle due to hormonal fluctuations), is enlightening. We understand that during certain phases of the menstrual cycle, especially the perimenstrual phase, the drop in progesterone levels can lower the seizure threshold in susceptible individuals. While severe menstrual pain alone is not typically a direct cause of seizures, we acknowledge that the combination of hormonal changes, stress, and physical discomfort might contribute to a lowered seizure threshold in someone predisposed to seizures.

Regarding the use of birth control pills, we are aware that hormonal contraceptives can have varying effects on seizure activity. Some studies suggest that certain hormonal contraceptives might influence seizure patterns in women with epilepsy. However, we also understand that the impact can differ based on the individual's neurological sensitivity and the specific formulation of the contraceptive.

Given that this was her first seizure, we agree that it is essential for her to consult a neurologist promptly. Undergoing diagnostic evaluations, such as an MRI (magnetic resonance imaging), helps identify physical abnormalities such as tumors, scarring, or developmental issues that might contribute to seizures. EEG (electroencephalogram), the brain's electrical activity, by recording brain waves through electrodes placed on the scalp, will help determine if there is an underlying condition. Additionally, tracking her menstrual cycles and any associated symptoms could provide valuable insights into potential patterns. In the interim, we will ensure she avoids activities that could pose risks, such as driving, swimming alone, or operating heavy machinery, until she receives medical clearance.

I hope this helps.

Thank you.