Evaluation of clinical evidences for progesterone therapy in catamenial epilepsy

Objective To formulate the best treatment plan for catamenial epilepsy patients by evaluating the efficacy and side effect of progesterone therapy via evidence-based medicine. Methods Catamenial epilepsy, drug therapy, progesterone, allopregnanolone, systematic review and randomized controlled trial (RCT) both in Chinese and English were used as retrieval words. Databases including Wanfang Data, VIP, China National Knowledge Infrastructure (CNKI), Cochrane Library, PubMed and Google Scholar were used with applying of manual searching. Systematic reviews, RCTs, open-label trials, prospective and retrospective case analysis, case-observation studies and reviews were collected and evaluated by Jadad Scale. Results After screening, 18 relevant resources were selected, including one systematic review, 3 RCTs, one open-label trial, 2 prospective case-controlled studies, one follow-up study and 10 reviews. Ten of the articles were evaluated to be high quality (Jadad Scale score ≥ 4), and the other 8 were of low quality (Jadad Scale score < 4). After the efficacy and safety of those clinical studies were evaluated, the results were summarized as follows: 1) progesterone combined with antiepileptic drugs (AEDs) was well tolerated and resulted in a significant reduction of seizure frequency in a majority of patients with catamenial epilepsy. 2) Both natural progesterone and synthetic progesterone could be used in the treatment for catamenial epilepsy. 3) There were two ways of progestogen therapy for catamenial epilepsy: cyclical progesterone hormone therapy and suppressive therapy. The former was more commonly used. Conclusions Using evidence-based medicine evaluation can provide best clinical evidence for the progesterone treatment on catamenial epilepsy. doi: 10.3969/j.issn.1672-6731.2014.12.007