Relationship of sexual dysfunction to epilepsy laterality and reproductive hormone levels in women

Gender issues in the neurobiology of epilepsy: A clinical perspective

“…In addition, sleep and mood can be deleteriously affected by hormonal disruptions (Duncan et al, 2009;Zelená et al, 2011). Even in patients without observable seizures, interictal epileptiform discharges especially from the right temporal lobe (Herzog et al, 2003b) that pass through to the hypothalamus cause release of gonadotropin-releasing hormone from the hypothalamus which in turn causes the release of gonadotropins such as lutenizing hormone and follicle-stimulating hormone (LH/FSH) which act on the periphery to produce testosterone in the Leydig cells and spermatozoa in the Sertoli cells in men, and estrogen and progesterone from ovaries in women. An elevation in prolactin levels further contributes to irregular menses or amenorrhea, galactorrhea and infertility.…”

Neuroendocrine Hormonal Conditions in Epilepsy

“…93 Induction of temporolimbic seizures in animals can cause changes both in reproductive hormone levels, reproductive function, 22 and sexual function. 105 In localization-related epilepsy, clinical investigations also indicate a close temporal relationship between the occurrence of temporolimbic discharges and pituitary hormone changes, and an association between epilepsy laterality in TLE and the occurrence of certain reproductive endocrine disorders. 106 On the other hand, idiopathic generalized epilepsy is a predictor of anovulatory cycles in women with epilepsy.…”

“…In TLE, the sexual functions in women with right-sided foci were affected more than women with left-sided foci. 105 Hyposexuality has been reported to be more prominent with right than with left temporolimbic foci. 127 The observation that left-sided TLE may be associated with PCOS and right-sided TLE may be associated with hypothalamic amenorrhea (hyperandrogenemia, hypogonadotropic hypogonadism), moreover, suggests a lateralized asymmetry in this relationship.…”

Management of epilepsy in women

“…Some AEDs may contribute to infertility in women, but women with epilepsy are less fertile than normal. A study of fertility ratios in women with epilepsy showed that the likelihood of pregnancy is considerably less than age matched controls, falling from 0.83 (0.54-1.21) in [15][16][17][18][19] year olds to 0.55 (0.14-1.39) at age 40-44. 18 This effect is likely to be multifactorial, including lowered libido, social and genetic factors, and not necessarily attributable to medication, although drugs may be a contributory factor.…”

“…This also applies to sexual dysfunction, which is more common in women with temporal lobe epilepsy, especially if the epileptiform discharges are on the right. 19 Furthermore, it has been estimated that about 8% of menstrual cycles are anovulatory in normal subjects, but it may be as high as a third of all cycles in women with temporal lobe epilepsy, 20 21 particularly if they are taking valproate. 22 Some AEDs have been associated with polycystic ovaries and the polycystic ovarian syndrome; valproate has been particularly implicated.…”