leuprolide and Seizures

A 7-year-8-month-old boy with cardiofaciocutaneous syndrome caused by the D638E mutation of the B-Raf proto-oncogene (BRAF) presented with new-onset seizures. He was incidentally found to have advanced Tanner staging on physical examination. Hormonal testing revealed pubertal levels of gonadotropins and sex steroid hormones. On brain imaging, a lack of visualisation of the posterior pituitary bright spot was observed, in addition to mild thinning of the corpus callosum and the lateral gyri of the cerebellar hemispheres. A diagnosis of idiopathic central precocious puberty was made and the patient was started on leuprolide depot treatment. Pituitary hormone testing revealed hyperprolactinemia for which the patient did not receive treatment as he was asymptomatic. During a subsequent hospital admission for seizures, the patient was diagnosed with transient central diabetes insipidus for which he required treatment with a desmopressin infusion.

Topics: Antineoplastic Agents, Hormonal; Child; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Ectodermal Dysplasia; Facies; Failure to Thrive; Heart Defects, Congenital; Hemostatics; Humans; Leuprolide; Male; Proto-Oncogene Mas; Proto-Oncogene Proteins B-raf; Puberty, Precocious; Seizures; Treatment Outcome

Topics: Adult; Antineoplastic Agents, Hormonal; Delayed-Action Preparations; Female; Fertility Agents, Female; Goserelin; Humans; Leuprolide; Nafarelin; Nasal Sprays; Seizures

Catamenial seizures are defined as epileptic seizures occurring during distinct phases of the menstrual cycle (i.e., periovulatory, premenstrually and during menstruation). The cyclic changes of the gonadotropic hormones are thought to be the main cause of the seizures. This hypothesis is supported by results of animal experiments, which have shown oestrogens to increase neuronal excitability whereas progesterone lowered it. We investigated 21 women with epilepsy who reported a catamenial increase in seizure frequency. Only 24% of these women actually exhibited a catamenial manifestation in more than 75% of seizures. The incidence of catamenial seizures is reported in the literature to be between 10% and 72%. Catamenial seizures are treated with anticonvulsant drugs. However, when anticonvulsants have failed to suppress seizures, progesterone or progesterone-derivates have been administered with success. We treated 16 patients with a synthetic GnRH-analogue to suppress the hormonal release of gonadotropins. Four of the six patients with only catamenial seizure manifestations and no other seizures became seizure free. Ten patients had catamenial seizures as well as seizures not related to the menstrual cycle. A decrease in seizure frequency by more than 50% was achieved in 7 of these 10 patients.

Topics: Adult; Anticonvulsants; Drug Therapy, Combination; Epilepsy, Temporal Lobe; Female; Gonadal Steroid Hormones; Gonadotropin-Releasing Hormone; Humans; Injections, Intramuscular; Leuprolide; Luteolytic Agents; Menstrual Cycle; Menstruation Disturbances; Middle Aged; Seizures; Triptorelin Pamoate