A Gender Affirming Experience; The RNS System Tracking Seizure Frequency During Gender Changing Hormonal Therapy
Rebecca Dutta1, Batool Hussain1, Sheela Toprani1, Jeffrey Kennedy1
1University of California, Davis
Objective:

Previous research has suggested that changes in estrogen may have a proconvulsant effect due to an increase in neuronal excitability. This poses a theoretical concern for patients who are undergoing feminizing hormone therapy and could have implications for their neurologic care.
We report on a case of a transgender patient with drug resistant right hemispheric focal epilepsy receiving responsive neurostimulation with the RNS® System who underwent gender affirming hormone therapy with the stimulator in place, offering objective data with electrocorticography regarding association of hormonal therapy during the gender change process.   

Background:
NA
Design/Methods:


Our patient is a 40-year-old who transitioned to female in adulthood. In childhood, she developed drug resistant focal epilepsy and underwent implantation of the Neuropace RNS system in January 2019. During the process of transitioning, our patient began receiving transdermal estradiol patches in July 2021. Spironolactone was prescribed in December 2021 and progesterone was added in January 2022. She was switched to intramuscular Estradiol injections in June 2022. No changes were made to the antiseizure medication regimen over this time. We followed subjective descriptions of seizure frequency and objective electrocorticography data between July 2021 to September 2024. 

Results:
Seizure frequency was reported to be 1-2 seizures or auras per month prior to hormone therapy. There was no significant change to patient reported seizure frequency until after 4-5 months with monthly aura clusters. In April 2022, seizures/auras were reported approximately every other day, which then improved by June 2022. At the next encounter in February 2023, seizures were reported to occur weekly with additional monthly clusters. From February 2023 to September 2024, seizure frequency stabilized. 
 
Conclusions:

Our patient’s experience suggests that feminizing hormone therapy may increase seizure frequency. There was an observed increase in RNS detection shortly after estrogen initiation, followed by a delayed increase in clinical seizures after 4-5 months.  

 

10.1212/WNL.0000000000210719
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.