The Effect of Phenytoin and Carbamazepine on Serum Dehydroepiandrosterone Sulfate in Men and Women Who Have Partial Seizures with Temporal Lobe Involvement *

Levesque, Linda; Herzog, Andrew G.; Seibel, Machelle M.

doi:10.1210/jcem-63-1-243

Cited by 54 publications

(42 citation statements)

References 8 publications

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“…Our results demonstrate a marked reduction in DHAS in all groups of patients receiving enzymeinducing AEDs. These findings confirm earlier reports of reduced DHAS in healthy male subjects treated with CBZ (Connell et al, 1984) and in a small number of male and a.larger group of female epileptic patients receiving CBZ and PHT (Levesque et al, 1986). The absence of such an effect in the VPA group supports enzyme induction as the likely mechanism.…”

Section: Discussionsupporting

confidence: 90%

Circulating Hormones and Pituitary Responsiveness in Young Epileptic Men Receiving Long‐Term Antiepileptic Medication

et al. 1988

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Impairment of libido and sexual potency are commonly reported by male epileptic patients. This may be partly a consequence of medication. Circulating hormones were measured in 53 postpubertal male epileptic patients less than 45 years of age and in an age-matched control group (n = 40), consisting of 14 untreated epileptic patients and 26 unmedicated healthy subjects. A subgroup also underwent a combined gonadotrophin- and thyrotrophin-releasing hormone (LH-RH/TRH) pituitary stimulation test. Untreated patients did not differ from healthy subjects for any parameter, and their data were combined for comparison with the treated epileptic patients. Total testosterone (T), androstenedione, and basal follicle-stimulating hormone concentrations were similar in all patient groups. Patients receiving more than one drug had higher sex hormone binding globulin (SHBG) (p less than 0.01) and lower free T and dehydroepiandrosterone sulphate (DHAS) levels (both p less than 0.001) than controls. Carbamazepine (CBZ) monotherapy also reduced free T (p less than 0.05) and DHAS (p less than 0.001) and increased basal prolactin (p less than 0.01). In these two groups of patients, basal luteinising hormone (LH) was elevated (p less than 0.01), presumably as a pituitary response to increased T catabolism. There was a negative correlation between free T and circulating CBZ (r = -0.54, p less than 0.05) in the monotherapy patients. Phenytoin (PHT) was associated with a rise in SHBG (p less than 0.01) and a fall in DHAS (p less than 0.001). Basal LH was also elevated, but this just failed to reach statistical significance (p less than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionsupporting

confidence: 90%

Circulating Hormones and Pituitary Responsiveness in Young Epileptic Men Receiving Long‐Term Antiepileptic Medication

et al. 1988

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“…29,30 The reduction in DHEAS has long been recognized to be a feature of enzyme-inducing antiepileptic drug (AED) use. 31 Neurologically, DHEAS is a highly neuroexcitatory steroid that potentiates glutamatergic and blocks ␥-aminobutyric acid-mediated conduction. 32 As such, reduction in concentrations may potentially lessen neuronal excitability and seizure tendencies.…”

Section: Reproductive Endocrine Function Differs Between Women With Tmentioning

confidence: 99%

“…7,11,23,[25][26][27][28]31 The clinical significance rests in the potential for this alteration to reach sufficient magnitude as to disrupt ovulation, luteinization, and hence lead to the development of reproductive endocrine disorders, menstrual disorders, and infertility. There is both animal experimental [42][43][44][45] and clinical 6,9,10,25-28 evidence, including the present findings, to suggest that this process might be the case.…”

Section: Reproductive Endocrine Function Differs Between Women With Tmentioning

confidence: 99%

“…Some enzyme-inducing drugs have been noted in the past to decrease DHEAS 27,31,59 and estradiol levels. [25][26][27][28] Because thyroid status impacts reproductive function, it is also important to note that enzymeinducing AED use has also been associated with abnormally low thyroxine and free thyroxine levels, often without compensatory elevation in thyrotropin.…”

Section: Reproductive Endocrine Function In Women With Temporolimbic mentioning

confidence: 99%

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Interictal EEG discharges, reproductive hormones, and menstrual disorders in epilepsy

Herzog¹,

Coleman²,

Jacobs³

et al. 2003

Annals of Neurology

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118

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We evaluated reproductive endocrine function in women with unilateral temporolimbic epilepsy and normal control subjects to assess the effects of epilepsy, epilepsy laterality, and antiepileptic drug use on the cerebral regulation of hormonal secretion. The findings indicate that reproductive endocrine function differs between women with epilepsy and normal control subjects. Significant differences exist at all levels of the reproductive neuroendocrine axis, that is, hypothalamus, pituitary, and peripheral gland. Differences show significant relationships to the epilepsy itself as well as to medication use. Reproductive neuroendocrine changes occur in a stochastic manner such that the laterality of unilateral temporolimbic discharges is associated with predictable directional changes in hormonal secretion at all levels of the reproductive neuroendocrine axis. These directional changes are consistent with the finding that different reproductive disorders may develop in relation to left- and right-sided temporolimbic epilepsy. Hormonal changes can show close temporal relationship to the occurrence of interictal epileptiform discharges and may vary in relation to the laterality of the discharges. Antiepileptic drugs differ in their effects on reproductive hormone levels. There are notable differences between enzyme-inducing and noninducing drugs. Menstrual disorders are more common among women with interictal discharges as well as women with abnormal hormonal findings.

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“…38 Of note, serum DHEAS levels are substantially reduced by enzyme-inducing antiepileptic drugs such as phenytoin and carbamazepine. 39,40 Progesterone also potentiates the action of the powerful endogenous inhibitory substance adenosine. 41 Progesterone itself also substantially diminishes nicotinic acetylcholine receptor-mediated conductance, which may be relevant to autosomal dominant nocturnal frontal lobe epilepsy.…”

Section: Progesteronementioning

confidence: 99%

Hormonal Therapies: Progesterone

Herzog¹

2009

Neurotherapeutics

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Summary:Seizures do not occur randomly in the majority of people with epilepsy. They tend to cluster. Seizure clusters, in turn, commonly occur with a temporal rhythmicity that shows a readily identifiable and predictable periodicity. When the periodicity of seizure exacerbation in women conforms to that of the menstrual cycle, it is commonly known as catamenial epilepsy. This may be attributable to 1) the neuroactive properties of steroid hormones and 2) the cyclic variation in their serum levels. If hormones play a role in seizure occurrence, hormones may also have a role in treatment. Progesterone has potent GABAergic metabolites that may provide safe and effective seizure control in women who have catamenial epilepsy.

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The Effect of Phenytoin and Carbamazepine on Serum Dehydroepiandrosterone Sulfate in Men and Women Who Have Partial Seizures with Temporal Lobe Involvement *

Cited by 54 publications

References 8 publications

Circulating Hormones and Pituitary Responsiveness in Young Epileptic Men Receiving Long‐Term Antiepileptic Medication

Circulating Hormones and Pituitary Responsiveness in Young Epileptic Men Receiving Long‐Term Antiepileptic Medication

Interictal EEG discharges, reproductive hormones, and menstrual disorders in epilepsy

Hormonal Therapies: Progesterone

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