Disorders of reproduction in epilepsy
Disclosure: We have received research support during the years from Desitin Pharma, UCB and GSK
58 slide(s) – 00:23:10– English –2010-09-26
Reproductive endocrine disorders are common among people with epilepsy. In women, menstrual disorders, polycystic ovaries, and infertility have been described, and in men, reduced potency and sperm abnormalities have been found. The reasons for this are multifactorial, including both the epilepsy itself and the antiepileptic medication. Epileptic activity can directly affect hypothalamic function. In female rats, amygdala-kindled seizures arrest ovarian cyclicity and alter endocrine function. The effects are highly lateralized. In women, patients with left temporal lobe epilepsy (TLE) have a higher GnRH pulse frequency associated with a higher frequency of polycystic ovaries. Right unilateral TLE is associated with lower GnRH pulse frequency and hypothalamic amenorrhea. Abnormal prolactin pulses after epileptic discharges will also affect reproductive function. In men, temporolimbic epilepsy may be associated with altered gonadotropin response to GnRH, more variable LH pulse frequency, and acute elevation in prolactin. In male rats, both amygdaloid and generalized seizures markedly disturb normal reproductive physiology.Antiepileptic drugs (AEDs) may also influence reproductive function. Enzyme inducing AEDs increase SHBG concentrations leading to lower bioactive testosterone and estradiol levels in both men and women. This may lead to menstrual disorders in women and reduced potency in men. In women, valproate is associated with menstrual disorders, polycystic ovaries, and hyperandrogenism. The effect seems to be age-dependent as young females are more vulnerable. In men, the clinical significance of valproate related endocrine changes is minor. Lamotrigine has so far not been shown to have any clinically important reproductive effects while information on newer AEDs is lacking.