Seizure Exacerbation and Hormonal Cycles

Diana Bordalo; Raquel Oliveira; Paula Fonseca; Teresa Temudo

doi:10.1542/pir.2019-0257

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Diana Bordalo, MD*
Raquel Oliveira, MD^†
Paula Fonseca, MD*,^‡
Teresa Temudo, PhD^§

^*Department of Pediatrics,
^‡Adolescent Medicine Unit, Unidade de Vila Nova de Famalicão, Vila Nova de Famalicão, Portugal;
^†Department of Pediatrics, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal;
^§Neuropediatric Unit, Department of Pediatrics–Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, E.P.E. Porto, Portugal

AUTHOR DISCLOSURE
Drs Bordalo, Oliveira, Fonseca, and Temudo have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 16-year-old girl presents to the pediatric emergency department after an episode of loss of consciousness, preceded by dizziness and followed by a generalized tonic-clonic seizure that lasted ∼10 minutes, with spontaneous recovery. She reports 2 previous episodes of loss of consciousness, one not witnessed, the other interpreted as a vasovagal syncope. Family history is positive for epilepsy in a great-grandmother. She has been otherwise previously healthy. Upon physical assessment, she is hemodynamically stable, nonfebrile, and has a normal neurological examination. Initial laboratory findings are normal, including urine toxicology screening, serum electrolytes, and inflammatory markers. An electrocardiography and an electroencephalography (EEG) performed 24 hours after the seizure are normal. Continuous ambulatory electrocardiography monitoring is normal. Due to the atypical seizure presentation with unwitnessed episodes, a tilt table test and a brain magnetic resonance imaging are performed, both reported as normal.

During the follow-up period, the patient has recurrent seizures, and notes that these episodes follow a monthly pattern, always on the third day of the menstrual cycle. She had her menarche at ∼12 years old with irregular periods for the first 2.5 to 3 years, during which time she was seizure-free. She currently experiences some …