Circalunar and ultralunar periodicities in women with partial seizures

Mark Quigg, Kristen M. Fowler, Andrew G. Herzog, Donald Schomer, Edward Bromfield, Barbara Dworetzky, Sonia Replansky, Cynthia L. Harden, Blagovast Nikolov, Alison Pack, Alison Randle, Barbara Jobst, Gregory Holmes, Emily Clough, Page Pennell, Melanee Newman, Gregory Krauss, Peter Kaplan, Faith Muigai, Teresa TranSabina Gapany, Eva Andermann, Frederick Andermann, Suha Mercho, Joyce Liporace, Michael Sperling, Gwendolyn Taylor, Laura Kalayjian, Christianne Heck, Sandra Oviedo

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Purpose: Little consensus exists for the definition of catamenial epilepsy. Few studies have evaluated the periodicity of seizures to test the hypothesis that seizures in women have periodic patterns of occurrence independent of a priori hormonal considerations. In the present study, we determined seizure periodicity according to a "menstrual clock" provided by a common phase marker of the onset of menses. Methods: Seizure and menstrual diaries of ∼3 months duration were obtained from women enrolled in a trial of hormonal therapy for localization-related epilepsy. Midluteal progesterone levels identified ovulatory (≥5 ng/ml, OC) from anovulatory cycles (AC). Individual cycles were normalized to a common phase and period (day 0 = menses onset, intervening days = 28 bins). Periodicity of combined data was estimated with cosinor-nonlinear least squares analysis. Best-fit rhythms were estimated with 95% confidence limits. Results: 100 patients provided 3344 seizures within 293 cycles (77% OC, 20% AC, indeterminate 3%). OC seizures displayed a circalunar rhythm with peak phase of occurrence at onset of menses. AC seizures also featured a circalunar rhythm that peaked at menses onset but also had ultralunar rhythms of ∼14 and ∼9 days. Discussion: Seizures in women with epilepsy occur in circalunar rhythms. OC and AC seizures differ in seizure timing with the latter occurring in ultralunar rhythms in addition to the predominant circalunar rhythm. This finding supports the existence of catamenial epilepsy and differences in patterns of seizure occurrence between OC and AC.

Original languageEnglish (US)
Pages (from-to)1081-1085
Number of pages5
Issue number6
StatePublished - Jun 2008
Externally publishedYes


  • Catamenial epilepsy
  • Chronobiology
  • Menses
  • Partial seizures

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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