Cykliczne napady padaczki związane z miesiączką czy inne cykliczne napady? Przegląd badań naukowych
Monthly or menstrual? A scoping review of catamenial epilepsy and non-menstrual seizure rhythms
W skrócie
Badanie pokazuje, że padaczka związana z cyklem miesiączkowym (catamenial epilepsy) nie ma jasnej i powszechnie przyjętej definicji, co prowadzi do błędnych diagnoz i nieodpowiedniego leczenia hormonalnego. Naukowcy odkryli, że podobne cykliczne napady padaczki pojawiają się co miesiąc u wielu osób, niezależnie od płci, co jeszcze bardziej utrudnia rozpoznanie tej konkretnej formy padaczki. Autorzy apelują o ulepszone metody diagnostyczne i dłuższe obserwacje pacjentów, aby lepiej zrozumieć rzeczywiste cykle napadów padaczki i zapobiec błędom w leczeniu.
Oryginalny abstract (angielski)
OBJECTIVE: Despite the reported high prevalence of catamenial epilepsy (CE), the condition remains poorly defined, with lack of consensus on what entails a menstrual-related seizure exacerbation. Emerging evidence of multiday cycles of seizure activity, including about-monthly cycles, present in both men and women, further confound the existence of CE. Issues of misdiagnosis, attribution bias, and potentially inappropriate hormonal therapies are relevant downstream effects of poorly defined CE. The purpose of this focused review was to examine the current literature on defining CE, alongside non-specific monthly seizure cycles, and appraise the most commonly utilized diagnostic methods. Against this background, we aim to identify limitations with current CE diagnostics in order to improve the methods of studying epilepsy chronobiology. METHODS: A scoping review on all primary source literature reporting on CE using the Ovid MEDLINE and EMBASE databases was conducted. Studies were limited to clinical trials and case reports, which were then classified by the CE definition utilized and length of diagnostic monitoring. This was repeated for literature on non-specific, multidien seizure cycles. RESULTS: Overall, 70 CE studies were included of the 233 studies screened (30.0%). Of these, most did not define or specify CE criteria utilized (52.9%). Studies predominantly did not specify the duration of seizure and menstrual-data recording before the establishment of a CE diagnosis (47.1%), and if specified, was most frequently for 3 months or less (32.9%). In general, the literature on multidien seizure cycles (n = 33) had longer average recording periods (24 months), more multimodal recording, balanced sexes, and conducted more significance testing. SIGNIFICANCE: Current definitions on CE are fragmented in the literature. The common methods of workup cannot reliably differentiate CE from other monthly rhythms evident equally in men, women, and children. Current time-based diagnoses of CE have limited ability to extrapolate into an accurate long-term rhythm.