Abstract Details

Title Changes in Seizure Frequency Vary Inversely with Changes in Allopregnanolone Levels in Progesterone-Treated Women with Catamenial Epilepsy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S48 - (-)

Poster/Presentation
Number 006

Objective

Background Animal studies suggest that AP, a progesterone metabolite and positive allostearic modulator of GABAA, may reduce neuronal excitability and raise seizure thresholds. Clinically, the NIH Progesterone Trial showed that the level of perimenstrual seizure exacerbation (C1 level), expressed as multiples of the combined mid-follicular and mid-luteal average daily seizure frequency, was the best predictor of ?50% progesterone responders. C1 ?3 level was associated with a significantly greater responder rate with progesterone (37.8%) than placebo (11.1%).

Design/Methods The AP data come from 155 subjects who had baseline and treatment phase mid-luteal serum samples drawn each cycle for hormone measurements in the NIH Progesterone Trial that compared the efficacy of adjunctive cyclic natural progesterone therapy vs placebo treatment of intractable seizures in 294 subjects randomized 2:1 to progesterone or placebo, stratified by catamenial and non-catamenial status (Herzog et al. 1997). It compared treatments on proportions of 50% responders and changes in seizure frequency from 3 baseline to 3 treated cycles. AP was measured by RIA (Frye & Bayon, 1999). We assessed the relationship between changes in AP levels and seizure frequencies from baseline to treatment using Pearson correlations.

Results There was no significant correlation between percentage changes in AP levels and seizure frequencies from baseline to treatment overall. There was a significant correlation for subjects who had C1 ?3 level of perimenstrual seizure exacerbation: r = -442, p = .013 and specifically for C1 ?3 progesterone treated subjects (r = -.452, p = .035) but not other groups (C1 ?3 placebo: r = -.318, C1<3 progesterone: r = -.099, C1 <3 placebo: r = -.131; p = NS).

Conclusions AP may be a mediator of seizure reduction in progesterone treated women with perimenstrually exacerbated catamenial epilepsy.

Authors/Disclosures
Andrew G. Herzog, MD, MSc, FAAN PRESENTER	Dr. Herzog has nothing to disclose.
Cheryl Frye	No disclosure on file
	No disclosure on file

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