Priority 13 from the Epilepsy (Canada) PSP

UNCERTAINTY: Is there a relationship between hormonal changes (e.g. puberty, menopause, pregnancy) and seizure onset and/or frequency, and what are the effects of seizures during pregnancy?  (JLA PSP Priority 13)
Overall ranking 13
JLA question ID 0110/13
Explanatory note While it is known that the menstrual cycle can affect the severity and frequency of seizures (catamenial seizures), it is generally unclear how hormonal changes impact seizure activity. Seizures may be affected by phases of marked hormonal changes such as puberty, menopause and pregnancy, but a precise causal link has not been established. Seizures can also occur in areas of the brain that are closely linked to structures that regulate hormones, which may affect hormone levels. While it is clear that certain hormones can act on brain cells and influence seizure activity,  these relationships are complex and can be affected by different factors. It is also unclear if and how seizures during pregnancy can affect the development of the fetus, and how epilepsy may be linked to reproductive disorders in women.  

Maguire, M. J., & Nevitt, S. J. (2019). Treatments for seizures in catamenial (menstrual‐related) epilepsy. Cochrane Database of Systematic Reviews(10). doi:10.1002/14651858.CD013225.pub2

Harden, C. L., Hopp, J., Ting, T. Y., Pennell, P. B., French, J. A., Allen Hauser, W., . . . Le Guen, C. (2009). Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee o. Epilepsia, 50, 1229-1236. doi:10.1111/j.1528-1167.2009.02128.x

Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of epilepsy in adults. Edinburgh: SIGN; 2015.
(SIGN publication no. 143). [May 2015]. Available from URL:

Haruna, M., Matsuzaki, M., Ota, E., Shiraishi, M., Hanada, N., & Mori, R. (2019). Guided imagery for treating hypertension in pregnancy. Cochrane Database of Systematic Reviews(4). doi:10.1002/14651858.CD011337.pub2

Weston, J., Bromley, R., Jackson, C. F., Adab, N., Clayton‐Smith, J., Greenhalgh, J., . . . Marson, A. G. (2016). Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. Cochrane Database of Systematic Reviews(11). doi:10.1002/14651858.CD010224.pub2

Health Research Classification System category Neurological 
Extra information provided by this PSP
Original uncertainty examples Does menopause have any effect on having seizures? ~ Are hormones related to seizures? (Seizures at the age of 6-8, then at age of 13 onwards). After sexual activities? ~ Are my seizures related to my menstral cycle?  Where did my sex drive go? And my memory? ~ How do fluctuations in seizure frequency relate to hormones (e.g., adolescence, peri-menstrual)
Submitted by People with Seizures x 9, Caregivers x 2, Friend or Family Member x 1, Health Care provider x 3
PSP information
PSP unique ID 0110
PSP name Epilepsy (Canada)
Total number of uncertainties identified by this PSP. 96  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 6th & 7th April 2021