Obesity, polycystic ovarian syndrome and thyroid dysfunction in women with epilepsy

Abstract

Introduction:Women with epilepsy (WWE) have an increased risk for several endocrine disorders. Obesity and Polycystic Ovarian Syndrome (PCOS) are common side-effects of anticonvulsant drugs.Aim:To study the prevalence of Obesity, PCOS, Thyroid dysfunction in WWE on monotherapy with Carbamazepine (CBZ), Sodium Valproate (VAL) and Phenytoin (DPH)Material and Methods:Sixty WWE in the reproductive age group (13 – 45 yr) who are on atleast 6 months of monotherapy with either CBZ (20) or VAL (20) or DPH (20) are subjects of the study. Their Anthropometric data is recorded. They are interviewed and investigated for PCOS and thyroid dysfunction. Twenty healthy women in the reproductive age group served as controls. BMI>25 is taken as cut-off for Obesity. PCOS is defined as menstrual irregularity and/or clinical /biochemical hyperandrogenism with ultrasound evidence of PCO as per the Rotterdam criteria. TSH <0.1 and >4 is taken as evidence of thyroid dysfunction. Women are grouped according to the anticonvulsant drug received and the data analyzed in each group.Results:The mean BMI among VAL and CBZ users is significantly higher than among DPH users (23.3 & 23.4 vs 20.4). There is no significant difference in incidence of PCOS among WWE using either DPH or VAL or CBZ. Elevated TSH>4 is seen more often in WWE on VAL (9/20) compared to CBZ (6/20) and DPH (3/20). WWE on CBZ, VAL and DPH did not differ in mean BMI, Obesity, PCOS compared to healthy controls. As compared to healthy controls, more WWE on drug therapy had significantly elevated TSH (1/20 vs20/60).Conclusions:WWE on VAL and CBZ had significant weight gain compared to DPH users. Despite weight gain, there was no difference in the incidence of PCOS between the users of VAL, CBZ and DPH. As compared to healthy controls, more WWE on drug therapy had significantly elevated TSH, more so in the VAL group.

Comparison of body composition in persons with epilepsy on conventional & new antiepileptic drugs

“…There are previous studies demonstrating neutral effect of CBZ 4 10 19 , PHT 5 15 and LTG 4 19 . However, some studies reported that women on CBZ and LTG had a greater BMI when compared with the control group 15 27 .…”

“…Previous studies 5 15 25 have reported increase in BMI in VPA treated subjects in a range of 2 to 4 kg/m 2 , however, de Vries et al 26 have reported no increase in BMI after VPA treatment. There are previous studies demonstrating neutral effect of CBZ 4 10 19 , PHT 5 15 and LTG 4 19 . However, some studies reported that women on CBZ and LTG had a greater BMI when compared with the control group 15 27 .…”

“…Statistical analysis : Considering the BMI (mean 23.4±4.321 kg/m 2 ) in Indian persons with epilepsy receiving six months of CBZ monotherapy in a previous study 15 ; anticipating 20 per cent reduction in mean BMI in patients with new AEDs and with significance level (alpha) 5 and 80 per cent power, a sample size of 14 subjects per group was estimated for the study.…”

Comparing the frequency of polycystic ovary syndrome in women with and without epilepsy

“…In a study by Ayyagari et al . in the year 2012,[ 7 ] which was performed with an aim of studying the PCOS, overweight, and thyroidal disorders in sixty women with epilepsy, they concluded that disorders in endocrine glands during fertility such as PCOS and hyperprolactinemia increase in epileptic women which is a basis for the occurrence of menstrual disorders, galactorrhea, and hirsutism in these persons. Furthermore, Bauer et al .…”

A Meta-Analysis of PCOS-Related Reproductive Abnormalities in Women Taking Valproate for Epilepsy

“…Besides, considering the treatment for PCOS, if women treated with VPA are affected with PCOS or its characteristics, they may consider taking drugs to improve the reproductive endocrine phenotype. However, there are several studies [3,18,55] displaying different results. Despite the publication of a paper on a similar topic [25], there has been no new meta-analysis in the last decade to summarize the effects of VPA on reproductive endocrinology as more clinical studies have emerged.…”