A case-control study assessing estrogen-progesterone ratio as a biomarker of epilepsy in women

Background: The relationship between sex hormones and epilepsy has been explored with studies showing a bidirectional relationship. However, none has focused on potential use of Estrogen/Progesterone Ratio (EPR) as apossible promising biomarker of epilepsy.

Objective: The aim of this study was to determine the association between epilepsy and EPR among women and possible utilization as a biomarker.

Methods: This is a case-control cross sectional study consisting of randomly and purposefully selected 200 women in which 100 were Women with Epilepsy (WoWE) while the remaining 100 were Women Without Epilepsy (WoWoE) (i.e control). The 100 WoWE were randomly divided into two groups (with 50 each on Carbamazepine (CAR) and Levetiracetam (LVC) group). The diagnosis of epilepsy were in accordance with 2017 International League Against Epilepsy (ILAE) and supported by Electroencephalographic features. Statistical Package for Social Science (SPSS) version 22 was used for data analysis. Hormone sample collection was based on Enzyme Linked Immunosorbent Assay (ELISA) principles.

Results: There was higher Follicular Phase EPR(FP-EPR) [139.87±298.11 vs 50.65±54.21; p0.040], and higher Luteal Phase EPR(LP-EPR) [135.15±40.03 vs 40.03±37.70; p0.012] in WoWE compared to WoWoE. There was higher FP-EPR [173.25±399.57 vs 50.64±54.20; p0.036], and higher LP-EPR [171.36±354.00 vs 40.03±37.70; p0.011] in CAR group compared to control. There was also a significantly higher LP-EPR level among cases on LVC group compared to control [99.66±115.16 vs 40.03±37.70; p0.001]. There was no difference in the FP-EPR and LPEPR between CAR and LVC groups [173.25±399.87 vs 106.49±132.10; p0.275], [171.36±354.00 vs 99.66±115.16; p0.177].

Conclusion: There was a higher level of EPR in cases compared to control, however the EPR was comparable in cases on CAR and LVC. EPR might be a promising biomarker of epilepsy.