月経周期に関連したspike wave stupor

Spike Wave Stupor Related to Menstrual Cycles

　【抄録】　2例の月経周期に関連して出現するspike wave stupor（SWS）を報告した。第1例は39歳女性で27歳時に妊娠中絶手術後にもうろう状態および強直間代発作を呈するようになった症例で月経前に周期的にSWSが出現した。ダナゾールによる偽閉経療法を試みたが有効ではなかった。脳波では全般性多棘徐波複合を示し焦点性異常はみられなかった。第2例は37歳女性で20歳時に向反発作と二次性全般化発作が初発した。26歳頃より発作が増加し28歳頃より月経の前後にSWSを呈するようになった。脳波では右前頭側頭部に棘波焦点を認めたが極期には全般性棘徐波複合を示した。2例ともにバルプロ酸が症状の軽減に有効であったがspike wave stuporの周期性発現を抑えることは困難であった。文献例を合わせこれらの症例の臨床的特徴につき考察を加えた。

　We reported two cases of spike wave stupor (SWS) which were related with menstruation cycles. The first case; a woman of 39, since undergoing artificial abortion at the age of 27 has shown a twilight state persisting for 1 or 2 days and generalized convulsion before menstruation every month. She had not received antiepileptic drugs (AED) as medication. During the twilight episode, electroencephalography showed continuing diffuse slow polyspike and wave complexes. Pseudomenopausal therapy using danazol failed to control SWS. Valproic acid (VPA) was effective for shortening of SWS duration, but SWS is still persisting. The second case, a woman of 37, had had a brief psychotic episode when she was 20. At that time she had her first convulsive seizure. The seizures were not controlled completely by AED. When she was 28, she showed a twilight state after convulsive seizures and it was correlated with her menstrual cycles. Such episodes appeared chiefly before and after menstruation. At the beginning of the SWS state, electroencephalography showed right temporal spikes, but in the state of deep stupor diffuse spike and wave bursts were observed. VPA was effective, but SWS is still continuing at the perimenstrual period. By reviewing a total of six cases of SWS that are correlated with menstruation in Japan, we discussed its clinical features.