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| |  Antiepileptic Medications May Be Risk Factors for Premenstrual Dysphoria: Presented at AES 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]
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