My wife has seizures. Can hormone replacement therapy help her?

Question

Hi doctor,

My 41-year-old wife started having seizures six months ago out of nowhere, and it is destroying our family. She has had five tonic–clonic seizures so far. The first one happened right in front of our kids, and they still have nightmares about it.

Her MRI showed possible cortical dysplasia in the left temporal lobe, and her EEG has sharp waves on that side. The neurologist started her on levetiracetam 1,000 mg twice daily, but she is having terrible mood swings and rage episodes that are completely unlike her.

She screamed at our 8-year-old daughter last week over nothing and then cried for hours afterward.

Her prolactin level right after the last seizure was 156 ng/mL, which confirmed it was a real seizure. She is also perimenopausal with irregular periods, and I’m wondering whether hormone changes triggered the epilepsy.

We had to take away her car keys, which she hates, and now I have to drive her everywhere. She works as an accountant and has made mistakes on tax returns during absence seizures; she did not even realize she was having them.

I am also worried about her being alone during the day. What if she has a seizure in the shower or while cooking?

Can hormone replacement therapy help control seizures?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand how difficult this must be for your family.

Your wife’s MRI (magnetic resonance imaging) showing left temporal cortical dysplasia, along with EEG (electroencephalogram) findings of sharp waves, confirms a structural cause of temporal lobe epilepsy.

This means her seizures are arising from a small abnormal area in the brain, not from stress or lifestyle factors alone.

Levetiracetam is an effective antiseizure medication, but it commonly causes mood swings, irritability, and emotional outbursts, particularly in women or those approaching menopause. These are well-recognized side effects.

If they persist, her neurologist can safely transition her to another medication, such as Lamotrigine or Oxcarbazepine, which are often better tolerated emotionally.

Perimenopausal hormonal changes can sometimes worsen seizures, as estrogen may increase seizure activity while progesterone has a protective effect.

Hormone replacement therapy is not a standard treatment for epilepsy, but in selected women with clear cycle-related seizure worsening, progesterone therapy under joint care from a neurologist and gynecologist may be beneficial.

Safety is essential until her seizures are fully controlled; she should not drive, avoid locking doors while bathing, and use showers rather than bathtubs.

Cooking should be done when someone else is nearby, using back burners and long-handled utensils.

The absent spells you describe are likely focal impaired-awareness seizures, during which she briefly loses awareness but continues activity.

Once medications are optimized, these episodes usually improve, and memory function often recovers.

The mood and behavioral changes you are seeing are part of the illness and medication effects, not her fault. Counseling and family therapy can help reduce tension and support your children’s emotional recovery as well.

I hope this helps.

Thank you.