The effect of epilepsy and antiepileptic drugs on sexual, reproductive and gonadal health of adults with epilepsy

Abstract

Epilepsy is a common chronic medical illness. Hyposexuality is the most frequent abnormality in men and women with epilepsy. In men with epilepsy, hypoandrogenimia, hypogonadism and sperm abnormalities are common. Testicular atrophy was also infrequently reported. In women with epilepsy, hyperandrogenism, polycystic ovaries (PCOs) and PCO syndrome are frequent. Decreased serum free testosterone, dehydroepiandrosterone levels, free androgen index and free testosterone/leutinizing hormone (LH) ratio and increased sex hormone binding globulin, estradiol, prolactin, LH, follicle stimulating hormone (FSH) levels and LH/FSH ratio are common with epilepsy. Disturbance of central and/or peripheral control of hypothalamic-pituitary-gonadal axis and alteration of central neurotrasmitters (GABA, glutamate and serotonin) by epileptic discharges or antiepileptic drugs (AEDs), direct gonadal toxicity by AEDs and pcyshicatric/psychosocial factors are all incriminated in sexual, reproductive and gonadal abnormalities associated with epilepsy. Patients may benefit from multidisplinary evaluation, tight seizure control, change the AED, androgen therapy, genital vasodilators, L-carnitine supplementation and psychotherapy.

Association between epilepsy and risk of sexual dysfunction: A meta-analysis

“…Research data showed that the proportion of SD in PWE varied across the studies, ranging from 38% to 71% and 23% to 60% in male and female patients, respectively [10][11][12][13]. Erectile dysfunction (ED), hyposexuality, and organic sexual problems were the common complaints in male PWE [14].…”

The effects of oxcarbazepine, levetiracetam, and lamotrigine on semen quality, sexual function, and sex hormones in male adults with epilepsy

“…Epidemiological surveys show that the prevalence of epilepsy is higher in males than in females . About 38%‐71% of men with epilepsy have sexual dysfunction, and fertility rates are only one‐third to one‐half of the rate in healthy people . Studies have investigated the effects of seizures themselves and some older antiepileptic drugs (AEDs; carbamazepine [CBZ], phenobarbital [PB], phenytoin [PHT], and valproic acid [VPA]) on the reproductive and sexual function of male patients with epilepsy .…”

“…1 About 38%-71% of men with epilepsy have sexual dysfunction, and fertility rates are only one-third to one-half of the rate in healthy people. 2 Studies have investigated the effects of seizures themselves and some older antiepileptic drugs (AEDs; carbamazepine [CBZ], phenobarbital [PB], phenytoin [PHT], and valproic acid [VPA]) on the reproductive and sexual function of male patients with epilepsy. [3][4][5] There have been relatively few studies of newer AEDs (oxcarbazepine [OXC], levetiracetam [LEV], or lamotrigine [LTG]), and some of them are controversial.…”

Connection Between Hormons and Antiepileptic Medicine

“…Enzim indüksiyonu yapan AEİ'lar, aromataz ve hepatik sitokrom P450 enzimlerini stimüle ederek biyolojik olarak aktif testesteron düzeyini azaltabilirler böylece seksüel fonksiyon bozukluğu ortaya çıkabilir. Enzim indüksiyonu yapan ilaçlar, serbest testesteron, dihidro testesteron, folikül stimulan hormon (FSH), luteizan hormon (LH) düzeyini azaltırlar ve seks hormonu bağlayıcı globulin (SHBG) ve estradiol düzeylerini artırırlar [7] (Tablo 1). KBZ, PHT, PB gibi AEİ'lar hepatik mikrozomal enzim indüksiyonu yapıcı özelliğe sahiptirler ve birlikte alındıkları diğer ilaçların metabolizmalarını hızlandırırlar ve SHBG üzerine etkirler.…”

“…GABA, glutamat ve seratonin gibi santral nörotransmiter değişiklikleri olmakta, doğrudan AEİ'lar gonadal toksisiteye yol açabilmekte ve psikiyatrik/psikososyal faktörler epilepsi ile birlikte seksüel, reprodüktif ve gonadal bozukluklara yol açmaktadır. [2,7] Nöbet lokalizasyonu ortaya çıkabilecek klinik tabloyu etkilemektedir. Örn.…”