Polycystic ovarian syndrome in Nigerian women with epilepsy on carbamazepine/levetiracetam monotherapy

Abstract

The study is aimed at comparing effects of older drugs like carbamazepine (CBZ) and newer agent like levetiracetam (LEV) on polycystic ovarian syndrome (PCOS) in women with epilepsy (WWE). Methods: An interviewer-based questionnaire was used to obtain relevant clinical information from 50 WWE on CBZ and LEV monotherapy, respectively, and 50 age-matched controls. The diagnosis of epilepsy was clinical with electroencephalographic features taken into consideration and the seizures classified using the 2017 International League Against Epilepsy classification. The diagnosis of PCOS was based on the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine. Results: The frequency of PCOS and its subcomponent were higher among WWE compare to controls. PCOS was present in 22 (44%) of LEV group compare to 8 (16%) CBZ group. The frequency of its subcomponent was higher among those on LEV except for comparable effect with regard to oligomenorrhea. The levels of the sex steroid hormone were comparable in both groups of WWE except luteal phase luteinizing hormone, which was lower among the LEV group (P .001). The follicular phase estradiol level was lower (P .021), and follicle-stimulating hormone level was about 2-fold higher (P .03) among WWE compare to controls. The mean value testosterone was significantly lower among controls compared to WWE. Conclusions: The increased frequency of PCOS and its subcomponent and the unsatisfactory effect of LEV compared to CBZ on reproductive endocrine function underscore the need for routine reproductive endocrine evaluation to improve overall quality of life.

Identifying risk factors for polycystic ovary syndrome in women with epilepsy: A comprehensive analysis of 248 patients

“…The study by Svalheim et al 37 demonstrated no significant effect of LEV on hormones in WWE. However, a recent study by Ogunjimi et al 14 showed that the proportion of PCOS in WWE with LEV monotherapy was significantly higher than that in those with CBZ monotherapy and healthy controls (44%, 16%, and 4%, respectively), which supports the findings of the present study. The rates of hyperandrogenism, hirsutism, and plasma T concentrations in patients undergoing LEV monotherapy were significantly higher than those in healthy controls and patients undergoing CBZ monotherapy.…”

“…The proportion of PCOS was significantly higher in WWE who had taken LEV for at least 1 year than in those who had taken the same for less than 1 year or never (22.97% vs. 12.64%, p = .0409). Since LEV is a relatively novel medication for epilepsy, only a few studies have been conducted on its effect on PCOS and reproductive endocrinology 14,37–39 . The study by Svalheim et al 37 demonstrated no significant effect of LEV on hormones in WWE.…”

“…2 The proportion of PCOS incidence has reached 15%-30% in WWE, [5][6][7][8] which is higher than that in women of the general population (6%-20%). 9 Both epileptic seizures [10][11][12] and anti-seizure medications (ASMs) 4,13,14 are considered to be associated with PCOS in WWE.…”

Research Progress on the Effect of Epilepsy and Antiseizure Medications on PCOS Through HPO Axis

“…ASMs may be safer than traditional drugs, and their reproductive endocrine effects have not been extensively studied. In addition, the effects of epilepsy and anti-epileptic drugs on reproductive endocrine function vary with factors such as the type of epilepsy, the age at onset of seizures, the age when treatment was initiated, and the types TABLE 1 | The influence of anti-seizure medications (ASMs) on the hypothalamic-pituitary-ovarian (HPO) axis (5,14,16,72,134,140,142,143).…”

“…Its reduction contributes to the development of IR (93) (Figure 3). the proportions are 44%, 20%, and 24% respectively (134). LEV may also affect the HPG axis of female rats (135).…”