Exercise, medication adherence, and the menstrual cycle: How much do these change seizure risk?

Abstract

People with epilepsy can experience tremendous stress from the uncertainty of when a seizure will occur. Three factors deemed important because of their potential influence on seizure risk are exercise, medication adherence, and the menstrual cycle. A narrative review was conducted through PubMed searching for relevant articles on how seizure risk is modified by 1) exercise, 2) medication adherence, and 3) the menstrual cycle. There was no consensus about the impact of exercise on seizure risk. Studies about medication nonadherence suggested an increase in seizure risk, but there was not a sufficient amount of data for a definitive conclusion. Most studies about the menstrual cycle reported an increase in seizures connected to a specific aspect of the menstrual cycle. No definitive studies were available to quantify this impact precisely. All three triggers reviewed had gaps in the research available, making it not yet possible to definitively quantify a relationship to seizure risk. More quantitative prospective studies are needed to ascertain the extent to which these triggers modify seizure risk.

Keywords: Epilepsy; Exercise; Medication adherence; Menstrual cycle; Seizure risk.

Figure 1.. PRISMA diagrams of literature searches.

PRISMA diagram flowcharts indicate the method used to find relevant review articles. (A) Reports excluded about exercise assessed risk of seizure-related injury while exercising, quality of life characteristics, self-determination to improve exercise behavior, or did not calculate seizure risk. (B) Reports excluded about medication adherence observed how cultural beliefs, personal background and history, and perception of capability and involvement with treatment influenced adherence. Reports excluded also assessed behavior changes, effectiveness of medication possession ratio at predicting non-adherence, and if single or combination anti-seizure medication had higher adherence. (C) Reports excluded about the menstrual cycle observed hormone fluctuation, if anovulatory cycles corresponded with normal cycle length, and ovarian hormones and progesterone deficit. Reports excluded also assessed occurrence of reproductive endocrine disorders.

Figure 2.. Three patterns of catamenial epilepsy.

As described in Herzog et al. 1997, three proposed patterns of catamenial epilepsy are: perimenstrual (C1) and periovulatory (C2) exacerbation during normal cycles, and entire second half of the cycle/luteal (C3) exacerbation during inadequate luteal phase cycles.