I was at a marketing event this week and ended up having a conversation about a teenage girl who had epilepsy. Natural remedies for seizures came up in conversation.
The seizures had begun about a year ago right around the time that her menstrual cycles started, and her seizures were tied to her menstrual cycles (the term for this type of seizure is “catamenial”). The answer from the “specialists” was to put her on anti-seizure meds as well as the birth control pill. Sounds great on the surface, but when you look a little deeper, you’ll see that this is not the best approach.
Progesterone is a hormone produced by both the adrenal glands and (in women), the ovum released by the ovary. While it has a long list of actions in the human body, one of the most important features of progesterone on the brain deals with allopregnanolone. Allopregnanolone is a hormone that your body produces from progesterone that has a very potent ability to calm the brain. Specifically, it works on the GABA receptors. Phenobarbital and the benzodiazepienes (like Valium, Ativan and Xanax act) on GABA receptors, so you probably have an idea of what GABA does.
Having healthy levels of progesterone is therefore important for brain health, especially where seizures are involved. Even more important is to avoid rapid changes in progesterone levels. For this reason, managing menstrual cycles of women with epilepsy is critical.
Managing menstrual cycles does NOT include using the birth control pill. The birth control pill does not fix anything. Even worse, the synthetic progesterone (called progestin) does NOT convert to allopregnanolone, so the brain loses out on the opportunity to make this protective compound. Because of this, using the birth control pill to help manage seizures in an adolescent is a bad idea and does nothing to fix the actual problem.
Menstrual irregularities in women frequently stem from imbalances between estrogen and progesterone. Prediabetes and environmental estrogen exposures (BPA, phthalates, flame retardants, etc…) are two of the biggest factors that throw off menstrual cycles and lead to a reduction in the amount of progesterone released from the ovum (inadequate luteal production of progesterone, or ILP).
Seizures that are related to the menstrual cycles (catamenial) need to be addressed from the standpoint of progesterone and menstrual irregularities. One of the tools that can be used for catamenial epilepsy is progesterone, given either orally or as a suppository.
It makes sense. It’s inexpensive, has an excellent safety profile compared to seizure drugs and it makes sense because it just supports the brain’s natural anti-seizure tools. But progesterone is a tool that is rarely used by neurologists for catamenial epilepsy.
The use of progesterone for seizures took a hit a few years back when Dr. Andrew Herzog, the most prominent researcher in the field of progesterone for seizures, had the results of a progesterone trial on temporal lobe epilepsy published. This trial did not find a benefit to the use of progesterone on temporal lobe epilepsy.
This was enough to support the neurologists’ opinions that progesterone use was worthless. But, it turns out the story wasn’t complete.
If you consider that progesterone for seizures is going to be the most effective for women who have catamenial epilepsy, the use of progesterone for all women might not make sense. Enter this particular study. In it, Dr. Herzog teased apart the data between women with catamenial epilepsy and those who did not.
Specifically, the study looked at the use of cyclic natural progesterone therapy for intractable seizures (non-responsive to medication) in 294 women. Turns out that the women who had more seizures around their menstrual cycle (3-fold or greater increase in average daily seizure frequency) had a much better response to the progesterone compared with women who had more seizures during other periods of their cycles (midfollicular and midluteal phases).
The bottom line is, used in an appropriate patient, progesterone can be a very powerful tool to help control seizures naturally. The problem is that few doctors will use even recognize the catamenial aspect of seizures (or migraines, for that matter), let alone understand that progesterone can be used in these scenarios.