1
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Alshakhouri M, Sharpe C, Bergin P, Sumner RL. Female sex steroids and epilepsy: Part 1. A review of reciprocal changes in reproductive systems, cycles, and seizures. Epilepsia 2024; 65:556-568. [PMID: 38036939 DOI: 10.1111/epi.17842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023]
Abstract
Seizures, antiseizure medications, and the reproductive systems are reciprocally entwined. In Section 2 of this review, we outline how seizures may affect the hypothalamic-pituitary-gonadal axis, thereby altering sex steroids, and changes in sex steroids across the menstrual cycle and changes in pharmacokinetics during pregnancy may alter seizure susceptibility. The literature indicates that females with epilepsy experience increased rates of menstrual disturbances and reproductive endocrine disorders. The latter include polycystic ovary syndrome, especially for females on valproate. Studies of fertility have yielded mixed results. We aim to summarize and attempt to detangle the existing knowledge on these reciprocal interactions. The menstrual cycle causes changes in seizure intensity and frequency for many females. When this occurs perimenstrually, during ovulation, or in association with an inadequate luteal phase, it is termed catamenial epilepsy. There is a clear biophysiological rationale for how the key female reproductive neurosteroids interact with the brain to alter the seizure threshold, and Section 3 outlines this important relationship. Critically, what remains unknown is the specific pathophysiology of catamenial epilepsy that describes why not all females are affected. There is a need for mechanism-focused investigations in humans to uncover the complexity of the relationship between reproductive hormones, menstrual cycles, and the brain.
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Affiliation(s)
| | - Cynthia Sharpe
- Department of Paediatric Neurology, Starship Children's Health, Auckland, New Zealand
| | - Peter Bergin
- Neurology Auckland Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Rachael L Sumner
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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2
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Li Q, Zhang Z, Fang J. Hormonal Changes in Women with Epilepsy. Neuropsychiatr Dis Treat 2024; 20:373-388. [PMID: 38436042 PMCID: PMC10906279 DOI: 10.2147/ndt.s453532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/17/2024] [Indexed: 03/05/2024] Open
Abstract
Epilepsy is a prevalent neurological disorder among women globally, often requiring long-term treatment. Hormonal fluctuations in women with epilepsy (WWE) can have reciprocal effects on epilepsy and antiseizure medications (ASMs), posing significant challenges for WWE. Notably, WWE commonly experience endocrine alterations such as thyroid dysfunctions, low bone metabolism, and reproductive hormone irregularities. On the one hand, the presence of hormones in women with epilepsy affects their susceptibility to epilepsy as well as the metabolism of antiseizure medications in various ways. On the other hand, epilepsy itself and the use of antiseizure medications impact the production, secretion, and metabolism of hormones, resulting in low fertility, increased risk of pregnancy complications, negative offspring outcomes, and so on. In order to develop more precise treatment strategies in the future, it is necessary to comprehend the explicit relationships between hormones, epilepsy, and antiseizure medications, as well as to elucidate the currently known mechanisms underlying these interactions.
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Affiliation(s)
- Qiwei Li
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People’s Republic of China
| | - Zhiyun Zhang
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People’s Republic of China
- Department of Neurology, The Mianyang Central Hospital, Mianyang, Sichuan Province, 621000, People’s Republic of China
| | - Jiajia Fang
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People’s Republic of China
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3
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Khan M, Bankar NJ, Bandre GR, Dhobale AV, Bawaskar PA. Epilepsy and Issues Related to Reproductive Health. Cureus 2023; 15:e48201. [PMID: 38050507 PMCID: PMC10693679 DOI: 10.7759/cureus.48201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Sexual disorders are prevalent and vary in men and women with epilepsy (WWE). Infertility and reproductive abnormalities are twice as common in females with epilepsy. Antiepileptic medications and seizures can both have an impact on sexual health in people with epilepsy. Seizures can alter the release of pituitary and hypothalamic hormones, and some antiepileptic drugs (AEDs) can alter sex steroid hormones (gonadal steroids and gonad corticoids). Females with epilepsy are more susceptible to menstrual cycle irregularity and polycystic ovary syndrome. Females and males had lower reproductive rates, and the causes are likely psychological and physiological, with epilepsy and AEDs again playing a role. Sexual disorders are common in WWE and men with epilepsy and can be caused by psychological, physical, or social factors. Specialists must address the gender-based biology of epilepsy and the impact of AEDs on sexual well-being to offer the best treatment possible for patients with epilepsy, particularly women of sexual maturity.
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Affiliation(s)
- Muskan Khan
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nandkishor J Bankar
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gulshan R Bandre
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anupama V Dhobale
- Obstetrics and Gynecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pranita A Bawaskar
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Cutia CA, Christian-Hinman CA. Mechanisms linking neurological disorders with reproductive endocrine dysfunction: Insights from epilepsy research. Front Neuroendocrinol 2023; 71:101084. [PMID: 37506886 PMCID: PMC10818027 DOI: 10.1016/j.yfrne.2023.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
Gonadal hormone actions in the brain can both worsen and alleviate symptoms of neurological disorders. Although neurological conditions and reproductive endocrine function are seemingly disparate, compelling evidence indicates that reciprocal interactions exist between certain disorders and hypothalamic-pituitary-gonadal (HPG) axis irregularities. Epilepsy is a neurological disorder that shows significant reproductive endocrine dysfunction (RED) in clinical populations. Seizures, particularly those arising from temporal lobe structures, can drive HPG axis alterations, and hormones produced in the HPG axis can reciprocally modulate seizure activity. Despite this relationship, mechanistic links between seizures and RED, and vice versa, are still largely unknown. Here, we review clinical evidence alongside recent investigations in preclinical animal models into the contributions of seizures to HPG axis malfunction, describe the effects of HPG axis hormonal feedback on seizure activity, and discuss how epilepsy research can offer insight into mechanisms linking neurological disorders to HPG axis dysfunction, an understudied area of neuroendocrinology.
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Affiliation(s)
- Cathryn A Cutia
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Catherine A Christian-Hinman
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL, USA; Department of Molecular and Integrative Physiology, University of Illinois Urbana-Champaign, Urbana, IL, USA; Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
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5
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Luqman O, Joseph Y, Akintomiwa M, Akinyinka A, Aderonke A, Bamidele O, David O, Mojisola OB, Bolanle F, Abdullahi M, Olatunbosun O, Fehintola F, Adesola O. Determinants of quality of life in Nigerian female patients with epilepsy on carbamazepine and levetiracetam monotherapy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Abstract
Background
The study is aimed to identify the predictors of Quality of Life (QOL) in women with epilepsy (WWE) on carbamazepine (CBM) and levetiracetam (LTM) monotherapy. 100 WWE were recruited (50 each on CBM and LTM), after clinical diagnosis of epilepsy supported by Electroencephalography (EEG) features and seizures classification by 2017 International League Against Epilepsy (ILAE) criteria, the Quality of Life Inventory Scale 31(QOLIE-31) and Zung Self-Rating Depression Scale (ZSRDS) were used to assess QOL and depression, respectively.
Result
Higher QOLIE-31 scores was seen in the LTM group across all domains except seizure worry (p = 0.051) compared to CBM group. Logistic regression showed that the use of CBM (p = 0.000), fast frequency on EEG (p = 0.005), longer duration of epilepsy (p = 0.017), presence of depression (p = 0.008) and lower level of education (p = 0.003) were predictors of QOL. Progesterone (p = 0.040), oestradiol (p = 0.011) and prolactin (p = 0.002) in follicular phase showed significant association with QOLIE-total score. In the luteal phase, luteinizing hormone–follicle stimulating hormone (LH–FSH) ratio (p = 0.009) and testosterone (p = 0.015), FSH (p = 0.015), prolactin (p = 0.000), showed significant association with QOL. None of the hormones independently predicts QOL.
Conclusion
LTM group appears to have better QOL than CBM group. Healthcare providers should focus on addressing these identified predictors which include medication effect, depression, Level of education, EEG background and duration of epilepsy with aim of improving QOL.
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6
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Lai W, Shen N, Zhu H, He S, Yang X, Lai Q, Li R, Ji S, Chen L. Identifying risk factors for polycystic ovary syndrome in women with epilepsy: A comprehensive analysis of 248 patients. J Neuroendocrinol 2023; 35:e13250. [PMID: 36942563 DOI: 10.1111/jne.13250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/04/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
To assess the risk factors for polycystic ovary syndrome (PCOS) in women with epilepsy (WWE) and develop a practical approach for PCOS screening based on clinical characteristic, blood indicator, and anti-seizure medication (ASM) profiles. This cross-sectional study was conducted with 248 WWE who were consecutively enrolled from the Epilepsy Center of West China Hospital between April 2021 and March 2022. The epilepsy characteristics, blood indicators, and use of ASMs were compared between WWE with and without PCOS. Multivariate logistic regression was used to identify the factors independently associated with PCOS. The differential analysis showed that younger age at onset of epilepsy (<13 years), a history of birth hypoxia, obesity (BMI ≥25 kg/m2 ), use of levetiracetam (LEV) (≥1 year), higher levels of cholesterol, luteinizing hormone (LH) and anti-Müllerian hormone (AMH), and lower levels of sex hormone-binding globulin were associated with PCOS (p < .05). Multivariate logistic regression identified that obesity (BMI ≥25 kg/m2 ), use of LEV (≥1 year), and higher levels of AMH and LH were independently associated with PCOS in WWE (p < .05). Obesity (BMI ≥25 kg/m2 ), LEV use (≥1 year), and elevated AMH and LH levels suggest an increased in the probability of occurrence of PCOS in WWE. The combination of these profiles provides a practical approach for screening PCOS in WWE.
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Affiliation(s)
- Wanlin Lai
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Ning Shen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Huili Zhu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Shixu He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Ximeng Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Qi Lai
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Shuming Ji
- Office of Programme Design and Statistics, Clinical Research Management Department, West China Hospital of Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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7
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Operto FF, Pastorino GMG, Viggiano A, Dell’Isola GB, Dini G, Verrotti A, Coppola G. Epilepsy and Cognitive Impairment in Childhood and Adolescence: A Mini-Review. Curr Neuropharmacol 2023; 21:1646-1665. [PMID: 35794776 PMCID: PMC10514538 DOI: 10.2174/1570159x20666220706102708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
Managing epilepsy in people with an intellectual disability remains a therapeutic challenge and must take into account additional issues such as diagnostic difficulties and frequent drug resistance. Advances in genomic technologies improved our understanding of epilepsy and raised the possibility to develop patients-tailored treatments acting on the key molecular mechanisms involved in the development of the disease. In addition to conventional antiseizure medications (ASMs), ketogenic diet, hormone therapy and epilepsy surgery play an important role, especially in cases of drugresistance. This review aims to provide a comprehensive overview of the mainfactors influencing cognition in children and adolescents with epilepsy and the main therapeutic options available for the epilepsies associated with intellectual disability.
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Affiliation(s)
- Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Andrea Viggiano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, SA, Italy
| | | | - Gianluca Dini
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
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8
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Ingram RJ, Leverton LK, Daniels VC, Li J, Christian-Hinman CA. Increased GABA transmission to GnRH neurons after intrahippocampal kainic acid injection in mice is sex-specific and associated with estrous cycle disruption. Neurobiol Dis 2022; 172:105822. [PMID: 35868435 PMCID: PMC9455811 DOI: 10.1016/j.nbd.2022.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 11/25/2022] Open
Abstract
Patients with epilepsy develop reproductive endocrine comorbidities at a rate higher than that of the general population. Clinical studies have identified disrupted luteinizing hormone (LH) release patterns in patients of both sexes, suggesting potential epilepsy-associated changes in hypothalamic gonadotropin-releasing hormone (GnRH) neuron function. In previous work, we found that GnRH neuron firing is increased in diestrous females and males in the intrahippocampal kainic acid (IHKA) mouse model of temporal lobe epilepsy. Notably, GABAA receptor activation is depolarizing in adult GnRH neurons. Therefore, here we tested the hypothesis that increased GnRH neuron firing in IHKA mice is associated with increased GABAergic drive to GnRH neurons. When ionotropic glutamate receptors (iGluRs) were blocked to isolate GABAergic postsynaptic currents (PSCs), no differences in PSC frequency were seen between GnRH neurons from control and IHKA diestrous females. In the absence of iGluR blockade, however, GABA PSC frequency was increased in GnRH neurons from IHKA females with disrupted estrous cycles, but not saline-injected controls nor IHKA females without estrous cycle disruption. GABA PSC amplitude was also increased in IHKA females with disrupted estrous cycles. These findings suggest the presence of an iGluR-dependent increase in feed-forward GABAergic transmission to GnRH neurons specific to IHKA females with comorbid cycle disruption. In males, GABA PSC frequency and amplitude were unchanged but PSC duration was reduced. Together, these findings suggest that increased GABA transmission helps drive elevated firing in IHKA females on diestrus and indicate the presence of a sex-specific hypothalamic mechanism underlying reproductive endocrine dysfunction in IHKA mice.
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Affiliation(s)
- Robbie J Ingram
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States of America
| | - Leanna K Leverton
- Department of Molecular and Integrative Physiology, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States of America
| | - Victoria C Daniels
- Department of Molecular and Integrative Physiology, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States of America
| | - Jiang Li
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States of America
| | - Catherine A Christian-Hinman
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States of America; Department of Molecular and Integrative Physiology, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States of America; Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States of America.
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9
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Frequency of menstrual abnormalities and their associated neuroimaging findings in women with focal refractory epilepsy. Acta Neurol Belg 2021; 121:1247-1250. [PMID: 32507941 DOI: 10.1007/s13760-020-01374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
Patients with refractory epilepsy can suffer from psychological and physical problems. Epilepsy can also be associated with menstruation abnormalities in women. In this paper, we aim to survey women with focal refractory epilepsy who also suffer from menstrual abnormalities. This cross-sectional study was performed in 2018 in Tertiary Epilepsy Center in Kashani Hospital, Isfahan, Iran and Milad hospital, Isfahan, Iran. A total number of 381 patients diagnosed with refractory epilepsy joined the study based on an inclusion and exclusion criteria. Clinical characteristics of epilepsy, menstrual issues and brain MRI findings were assessed. Among 381 women with refractory epilepsy, 250 had refractory focal epilepsy (65.61%), and the others (34.39%) had generalized refractory epilepsy. 132 patients out of 381 had menstrual abnormalities (34.65%). Among 132 women with coexisting refractory epilepsy and menstrual abnormalities, 86 (65.15%) were diagnosed with refractory focal epilepsy, and 46 (34.86%) had generalized refractory epilepsy (p value = 0.041). Oligomenorrhea-hypomenorrhea was the most common type of menstrual abnormality in women with refractory epilepsy seen in 83 (62.87%) (p value = 0.039). The most common brain MRI pathology in women with refractory focal epilepsy was mesial temporal sclerosis (MTS) (39.20%, p = 0.00). We report that almost one-third of women with refractory epilepsy suffer from menstrual disorders, and the most common disorder was Oligomenorrhea-hypomenorrhea, and the most common brain pathology was MTS. It has also been a hypothesis that reproductive dysfunctions are connected to temporal lobe malfunctions, and more specific studies are required in this issue.
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10
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Ogunjimi L, Yaria J, Makanjuola A, Alabi A, Osalusi B, Oboh D, Olusola‐Bello M, Olawale O, Ogunniyi A. Polycystic ovarian syndrome in Nigerian women with epilepsy on carbamazepine/levetiracetam monotherapy. Acta Neurol Scand 2021; 143:146-153. [PMID: 32885414 DOI: 10.1111/ane.13342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/14/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE 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.
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Affiliation(s)
- Luqman Ogunjimi
- Department of Pharmacology and Therapeutics Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - Joseph Yaria
- Department of Medicine University College Hospital Ibadan Nigeria
| | | | - Akinyinka Alabi
- Department of Pharmacology and Therapeutics Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - Bamidele Osalusi
- Department of Medicine Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - David Oboh
- Department of Radiology University College Hospital Ibadan Nigeria
| | - Mojisola Olusola‐Bello
- Radiology Unit Department of Surgery Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - Olatunbosun Olawale
- Department of Chemical Pathology and Immunology Obafemi Awolowo College of Health Sciences Olabisi Onabanjo University Sagamu Nigeria
| | - Adesola Ogunniyi
- Department of Medicine University College Hospital Ibadan Nigeria
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Christian CA, Reddy DS, Maguire J, Forcelli PA. Sex Differences in the Epilepsies and Associated Comorbidities: Implications for Use and Development of Pharmacotherapies. Pharmacol Rev 2021; 72:767-800. [PMID: 32817274 DOI: 10.1124/pr.119.017392] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The epilepsies are common neurologic disorders characterized by spontaneous recurrent seizures. Boys, girls, men, and women of all ages are affected by epilepsy and, in many cases, by associated comorbidities as well. The primary courses of treatment are pharmacological, dietary, and/or surgical, depending on several factors, including the areas of the brain affected and the severity of the epilepsy. There is a growing appreciation that sex differences in underlying brain function and in the neurobiology of epilepsy are important factors that should be accounted for in the design and development of new therapies. In this review, we discuss the current knowledge on sex differences in epilepsy and associated comorbidities, with emphasis on those aspects most informative for the development of new pharmacotherapies. Particular focus is placed on sex differences in the prevalence and presentation of various focal and generalized epilepsies; psychiatric, cognitive, and physiologic comorbidities; catamenial epilepsy in women; sex differences in brain development; the neural actions of sex and stress hormones and their metabolites; and cellular mechanisms, including brain-derived neurotrophic factor signaling and neuronal-glial interactions. Further attention placed on potential sex differences in epilepsies, comorbidities, and drug effects will enhance therapeutic options and efficacy for all patients with epilepsy. SIGNIFICANCE STATEMENT: Epilepsy is a common neurological disorder that often presents together with various comorbidities. The features of epilepsy and seizure activity as well as comorbid afflictions can vary between men and women. In this review, we discuss sex differences in types of epilepsies, associated comorbidities, pathophysiological mechanisms, and antiepileptic drug efficacy in both clinical patient populations and preclinical animal models.
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Affiliation(s)
- Catherine A Christian
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Doodipala Samba Reddy
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Jamie Maguire
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Patrick A Forcelli
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
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12
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Taubøll E, Isojärvi JIT, Herzog AG. The interactions between reproductive hormones and epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:155-174. [PMID: 34266590 DOI: 10.1016/b978-0-12-819973-2.00011-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There are complex interactions between hormones, epilepsy, and antiepileptic drugs (AEDs). While there is ample evidence that hormones influence epilepsy, it is also apparent that epileptic activity influences hormones in both women and men. In addition, AEDs may disturb endocrine function. The clinical importance of these interactions is primarily related to the effects on reproductive hormones, which is the focus of this article. Reproductive endocrine dysfunction is common among women and men with epilepsy. Menstrual disorders, polycystic ovaries, and infertility have been described among women with epilepsy, while reduced potency and sperm abnormalities have been found in men. Sexual problems and endocrine changes have been frequently described in both sexes. Epilepsy and AEDs can target a number of substrates to impact hormone levels. These include the limbic system, hypothalamus, pituitary, peripheral endocrine glands, liver, and adipose tissue. AEDs may also alter the synthesis of steroids and binding proteins, as well as hormone metabolism, and produce direct gonadal effects.
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Affiliation(s)
- Erik Taubøll
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | | | - Andrew G Herzog
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA, United States; Faculty of Medicine, Harvard Medical School, Boston, MA, United States
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Li S, Zhang L, Wei N, Tai Z, Yu C, Xu Z. Research Progress on the Effect of Epilepsy and Antiseizure Medications on PCOS Through HPO Axis. Front Endocrinol (Lausanne) 2021; 12:787854. [PMID: 34992582 PMCID: PMC8726549 DOI: 10.3389/fendo.2021.787854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022] Open
Abstract
Epilepsy is a common chronic neurological disease that manifests as recurrent seizures. The incidence and prevalence of epilepsy in women are slightly lower than those in men. Polycystic ovary syndrome (PCOS), a reproductive endocrine system disease, is a complication that women with epilepsy are susceptible to, and its total prevalence is 8%-13% in the female population and sometimes as high as 26% in female epilepsy patients. The rate of PCOS increased markedly in female patients who chose valproate (VPA), to 1.95 times higher than that of other drugs. In addition, patients receiving other anti-seizure medications (ASMs), such as lamotrigine (LTG), oxcarbazepine (OXC), and carbamazepine (CBZ), also have reproductive endocrine abnormalities. Some scholars believe that the increase in incidence is related not only to epilepsy itself but also to ASMs. Epileptiform discharges can affect the activity of the pulse generator and then interfere with the reproductive endocrine system by breaking the balance of the hypothalamic-pituitary-ovarian (HPO) axis. ASMs may also cause PCOS-like disorders of the reproductive endocrine system through the HPO axis. Moreover, other factors such as hormone metabolism and related signalling pathways also play a role in it.
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Affiliation(s)
| | | | | | | | | | - Zucai Xu
- *Correspondence: Changyin Yu, ; Zucai Xu,
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14
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Quon RJ, Meisenhelter S, Adamovich-Zeitlin RH, Song Y, Steimel SA, Camp EJ, Testorf ME, MacKenzie TA, Gross RE, Lega BC, Sperling MR, Kahana MJ, Jobst BC. Factors correlated with intracranial interictal epileptiform discharges in refractory epilepsy. Epilepsia 2020; 62:481-491. [PMID: 33332586 DOI: 10.1111/epi.16792] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate the influence that subject-specific factors have on intracranial interictal epileptiform discharge (IED) rates in persons with refractory epilepsy. METHODS One hundred fifty subjects with intracranial electrodes performed multiple sessions of a free recall memory task; this standardized task controlled for subject attention levels. We utilized a dominance analysis to rank the importance of subject-specific factors based on their relative influence on IED rates. Linear mixed-effects models were employed to comprehensively examine factors with highly ranked importance. RESULTS Antiseizure medication (ASM) status, time of testing, and seizure onset zone (SOZ) location were the highest-ranking factors in terms of their impact on IED rates. The average IED rate of electrodes in SOZs was 34% higher than the average IED rate of electrodes outside of SOZs (non-SOZ; p < .001). However, non-SOZ electrodes had similar IED rates regardless of the subject's SOZ location (p = .99). Subjects on older generation (p < .001) and combined generation (p < .001) ASM regimens had significantly lower IED rates relative to the group taking no ASMs; newer generation ASM regimens demonstrated a nonsignificant association with IED rates (p = .13). Of the ASMs included in this study, the following ASMs were associated with significant reductions in IED rates: levetiracetam (p < .001), carbamazepine (p < .001), lacosamide (p = .03), zonisamide (p = .01), lamotrigine (p = .03), phenytoin (p = .03), and topiramate (p = .01). We observed a nonsignificant association between time of testing and IED rates (morning-afternoon p = .15, morning-evening p = .85, afternoon-evening p = .26). SIGNIFICANCE The current study ranks the relative influence that subject-specific factors have on IED rates and highlights the importance of considering certain factors, such as SOZ location and ASM status, when analyzing IEDs for clinical or research purposes.
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Affiliation(s)
- Robert J Quon
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Stephen Meisenhelter
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Yinchen Song
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah A Steimel
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Edward J Camp
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Markus E Testorf
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Thayer School of Engineering at Dartmouth College, Hanover, New Hampshire, USA
| | - Todd A MacKenzie
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Dartmouth Institute, Dartmouth College, Hanover, New Hampshire, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Bradley C Lega
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael J Kahana
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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15
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Tao L, Duan Z, Liu Y, Hou H, Zhang X. Correlation of sexual dysfunction with sex hormone and estrogen receptor gene polymorphism in Chinese Han women with epilepsy. Epilepsy Res 2020; 169:106527. [PMID: 33360539 DOI: 10.1016/j.eplepsyres.2020.106527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/24/2020] [Accepted: 12/05/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Women with epilepsy (WWE) have a high risk of sexual dysfunction (SD). We aimed to investigate the incidence of SD, the correlation between SD, sex hormone and estrogen receptor (ER) gene polymorphism in Chinese Han WWE. METHODS This cross-sectional study examined 112 married WWE in the Affiliated Hospital of Yangzhou University who were taking antiepileptic drugs (AEDs) for ≥1 year, and 120 healthy controls without epilepsy, all of Chinese Han nationality. The age, menstruation, fertility of all the subjects and disease details of WWE were recorded. The Chinese version of female sexual function index (FSFI) was used to investigate the sexual function of the subjects. The chemiluminescence method was used for the detection of sex hormones, while polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene polymorphism. The differences of the sexual function, sex hormone, ER genotype, and allele frequency were compared between the two groups. The correlation between SD, sex hormone and ER gene polymorphism was also analyzed. RESULTS (1) A high rate (70.5%) of SD was detected in WWE. (2) The serum prolactin (PRL) level (P = 0.039) and the ratio of estradiol to progesterone (E2/P) (P<0.001) in the WWE group were significantly higher than those in the control group. The allele frequencies of ERα-PvuII C (P = 0.001) and ERβ-AluI A (P = 0.001) in the WWE group were significantly higher than those in the control group. (3) Binary logistic regression analysis showed that serum testosterone level [odds ratio (OR) = 0.412, 95 % confidence interval (CI): 0.201-0.842, P = 0.015], and PvuII CC genotype [odds ratio (OR) = 6.074, 95 % confidence interval (CI): 1.257-29.352, P = 0.025] were independently correlated with SD. CONCLUSION The incidence of SD in Chinese Han WWE is high. High serum testosterone levels may exert a protective effect on sexual function. ERα-PvuII polymorphism is related to the susceptibility of SD, and PvuII CC genotype may be the risk genotype of SD.
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Affiliation(s)
- Lihong Tao
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China.
| | - Zuowei Duan
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China.
| | - Yihui Liu
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China.
| | - Hongling Hou
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China.
| | - Xinjiang Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China.
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16
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Markoula S, Siarava E, Keramida A, Chatzistefanidis D, Zikopoulos A, Kyritsis AP, Georgiou I. Reproductive health in patients with epilepsy. Epilepsy Behav 2020; 113:107563. [PMID: 33242778 DOI: 10.1016/j.yebeh.2020.107563] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/16/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Abstract
The aim of the present study was to review existing knowledge on the impact of epilepsy in reproductive health of both sexes. Extensive searches of relevant documentation published until February 2020 were retrieved from PubMed and Google Scholar literature in English or in other languages with an English abstract. In females, epilepsy may lead to estrogen and androgen level abnormalities. Women with epilepsy may develop Polycystic Ovaries Syndrome (PCOS), anovulatory cycles, and menstrual disorders. In men, epilepsy may cause sex hormone dysregulation and influence spermatogenesis. Males with epilepsy may also suffer from sexual dysfunction. Antiepileptic drugs (AEDs) have adverse effects on peripheral endocrine glands, influence hormones' biosynthesis and protein binding, diminish the bioactivity of serum sex hormones, and lead to secondary endocrine disorders related to changes concerning body weight and insulin sensitivity. Valproic acid (VPA) was the first recognized AED to cause disturbances potentially due to metabolic changes and increasing weight. Women taking VPA may develop PCOS, while men may have sperm abnormalities and/or sexual dysfunction. Liver enzyme inducing AEDs may also cause menstrual and sexual disorders in women and sexual dysfunction in men. Newer AEDs are much safer but studies still suggest reduced sexuality and erectile dysfunction.
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Affiliation(s)
- Sofia Markoula
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Eleftheria Siarava
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece.
| | - Anna Keramida
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Dimitrios Chatzistefanidis
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Athanassios Zikopoulos
- Genetics and IVF Unit, Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, Ioannina 45110, Greece
| | - Athanassios P Kyritsis
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Ioannis Georgiou
- Genetics and IVF Unit, Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, Ioannina 45110, Greece
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17
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Stefanidou M, Montouris G. Reproductive and Sexual Health Concerns in Transition-Age Adolescents and Young Adults With Epilepsy. Semin Pediatr Neurol 2020; 36:100855. [PMID: 33308522 DOI: 10.1016/j.spen.2020.100855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A plethora of hormonal and physical changes occur as adolescents grow into adulthood. These changes pose additional challenges for youth with epilepsy. Providers, parents, and patients must be well educated about the hormonal influences, both intrinsic and pharmaceutical, on seizures and antiepileptics (AEDs). In addition, they must be made aware of safe/effective contraception, the importance of pregnancy planning, and potential menstrual and sexual health disturbances related to epilepsy and AEDS. Reproductive and sexual health should be an integral component of transition education and planning for all youth, but is especially important for the youth with epilepsy. While many clinicians will collaborate with adolescent gynecologists or pediatricians, it is important for all child neurologists to be aware of these issues.
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Affiliation(s)
- Maria Stefanidou
- Department of Neurology, Boston University School of Medicine, Boston, MA.
| | - Georgia Montouris
- Department of Neurology, Boston University School of Medicine, Boston, MA
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18
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Mazdeh M, Heidari M, Taheri M, Ghafouri-Fard S. Anticonvulsant drugs effects on sex hormone levels and sexual function in men with epilepsy. FUTURE NEUROLOGY 2020. [DOI: 10.2217/fnl-2019-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Sexual dysfunction is common in patients with epilepsy. The aim of this quasi-experimental study was to evaluate the effect of anticonvulsant drugs on hormonal and sexual function in men with epilepsy. Methods: Newly diagnosed patients with epilepsy were divided into three groups of 23 subjects who received monotherapy with sodium valproate, carbamazepine and levetiracetam, respectively. Findings: At the beginning of the study, sexual function and sexual hormones were comparable between the control group and the patient group (p > 0.05). After 6 months of treatment, patients who received sodium valproate had the weakest sexual function. Conclusion: According to the present findings, levetiracetam appears to be a good choice for sexually active patients compared with other conventional anticonvulsants.
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Affiliation(s)
- Mehrdokht Mazdeh
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahzad Heidari
- Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taheri
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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19
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Abstract
PURPOSE OF REVIEW This article provides the latest information to guide practitioners in counseling and treating women with epilepsy. RECENT FINDINGS There is an increasing body of literature on the multidirectional effects of sex hormones on seizure frequency and severity and of seizures altering areas of the brain involved in neuroendocrine function. Ongoing pregnancy outcome data from pregnancy registries and meta-analysis of observational studies have provided key information on the safety of using antiseizure medications during pregnancy and the risk to the fetus. SUMMARY In treating and counseling women with epilepsy from puberty to menopause, it is important to understand the complex interactions of sex hormones, seizures, and antiseizure medications on reproductive health and pregnancy outcomes.
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20
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Pennell PB, French JA, Harden CL, Davis A, Bagiella E, Andreopoulos E, Lau C, Llewellyn N, Barnard S, Allien S. Fertility and Birth Outcomes in Women With Epilepsy Seeking Pregnancy. JAMA Neurol 2019; 75:962-969. [PMID: 29710218 DOI: 10.1001/jamaneurol.2018.0646] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Prior studies report lower birth rates for women with epilepsy (WWE) but have been unable to differentiate between biological and social contributions. To our knowledge, we do not have data to inform WWE seeking pregnancy if their likelihood of achieving pregnancy is biologically reduced compared with their peers. Objective To determine if WWE without a prior diagnosis of infertility or related disorders are as likely to achieve pregnancy within 12 months as their peers without epilepsy. Design, Setting, and Participants The Women With Epilepsy: Pregnancy Outcomes and Deliveries study is an observational cohort study comparing fertility in WWE with fertility in control women (CW) without epilepsy. Participants were enrolled at 4 academic medical centers and observed up to 21 months from November 2010 to May 2015. Women seeking pregnancy aged 18 to 40 years were enrolled within 6 months of discontinuing contraception. Exclusion criteria included tobacco use and a prior diagnosis of infertility or disorders that lower fertility. Eighteen WWE and 47 CW declined the study, and 40 WWE and 170 CW did not meet study criteria. The Women With Epilepsy: Pregnancy Outcomes and Deliveries electronic diary app was used to capture data on medications, seizures, sexual activity, and menses. Data were analyzed from November 2015 to June 2017. Main Outcomes and Measures The primary outcome was proportion of women who achieved pregnancy within 12 months after enrollment. Secondary outcomes were time to pregnancy using a proportional hazard model, pregnancy outcomes, sexual activity, ovulatory rates, and analysis of epilepsy factors in WWE. All outcomes were planned prior to data collection except for time to pregnancy. Results Of the 197 women included in the study, 142 (72.1%) were white, and the mean (SD) age was 31.9 (3.5) years among the 89 WWE and 31.1 (4.2) among the 108 CW. Among 89 WWE, 54 (60.7%) achieved pregnancy vs 65 (60.2%) among 108 CW. Median time to pregnancy was no different between the groups after controlling for key covariates (WWE: median, 6.0 months; 95% CI, 3.8-10.1; CW: median, 9.0 months; 95% CI, 6.5-11.2; P = .30). Sexual activity and ovulatory rates were similar in WWE and CW. Forty-four of 54 pregnancies (81.5%) in WWE and 53 of 65 pregnancies (81.5%) in CW resulted in live births. No epilepsy factors were significant. Conclusions and Relevance Women with epilepsy seeking pregnancy without prior known infertility or related disorders have similar likelihood of achieving pregnancy, time to pregnancy, and live birth rates compared with their peers without epilepsy.
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Affiliation(s)
- Page B Pennell
- Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Women's Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacqueline A French
- Department of Neurology, New York University Comprehensive Epilepsy Center, New York
| | - Cynthia L Harden
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anne Davis
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Emilia Bagiella
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Evie Andreopoulos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Connie Lau
- Department of Neurology, Northwell Health, Great Neck, New York
| | - Nichelle Llewellyn
- Allegheny Health Network Research Institute, Allegheny Health Network, Pittsburgh, Pennsylvania.,Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah Barnard
- Department of Neurology, New York University Comprehensive Epilepsy Center, New York
| | - Stephanie Allien
- Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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21
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Does the age of seizure onset relate to menarche and does it matter? Seizure 2019; 69:1-6. [DOI: 10.1016/j.seizure.2019.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 01/17/2019] [Accepted: 03/24/2019] [Indexed: 11/23/2022] Open
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22
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Effect of valproate versus levetiracetam monotherapy on reproductive functions in newly diagnosed epileptic males. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0088-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Butler T, Harvey P, Cardozo L, Zhu YS, Mosa A, Tanzi E, Pervez F. Epilepsy, depression, and growth hormone. Epilepsy Behav 2019; 94:297-300. [PMID: 30773449 PMCID: PMC7980784 DOI: 10.1016/j.yebeh.2019.01.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 11/16/2022]
Abstract
Depression affects a large proportion of patients with epilepsy, and is likely due in part to biological mechanism. Hormonal dysregulation due to the disruptive effects of seizures and interictal epileptiform discharges on the hypothalamic-pituitary-adrenal axis likely contributes to high rates of depression in epilepsy. This paper reviews the largely unexplored role of neuroendocrine factors in epilepsy-related depression, focusing on Growth Hormone (GH). While GH deficiency is traditionally considered a childhood disorder manifested by impaired skeletal growth, GH deficiency in adulthood is now recognized as a serious disorder characterized by impairments in multiple domains including mood and quality of life. Could high rates of depression in patients with epilepsy relate to subtle GH deficiency? Because GH replacement therapy has been shown to improve mood and quality of life in patients with GH deficiency, this emerging area may hold promise for patients suffering from epilepsy-related depression.
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Affiliation(s)
- Tracy Butler
- Center for Brain Health, New York University School of Medicine, Department of Psychiatry, 145 East 32nd Street, New York, NY 10016, United States of America.
| | - Patrick Harvey
- Center for Brain Health, New York University School of Medicine, Department of Psychiatry, 145 East 32nd Street, New York, NY 10016, United States of America
| | - Lila Cardozo
- Center for Brain Health, New York University School of Medicine, Department of Psychiatry, 145 East 32nd Street, New York, NY 10016, United States of America
| | - Yuan-Shan Zhu
- Clinical and Translational Science Center, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America
| | - Adam Mosa
- University of Toronto School of Medicine, Division of Plastic and Reconstructive Surgery, 149 College Street, 5th Floor, Suite 508, Toronto, Ontario M5T 1P5, Canada
| | - Emily Tanzi
- Center for Brain Health, New York University School of Medicine, Department of Psychiatry, 145 East 32nd Street, New York, NY 10016, United States of America
| | - Fahad Pervez
- Clinical and Translational Science Center, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, United States of America
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24
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Aicua-Rapun I, André P, Novy J. Closed-loop Neuropharmacology for Epilepsy: Distant Dream or Future Reality? Curr Neuropharmacol 2019; 17:447-458. [PMID: 29521237 PMCID: PMC6520584 DOI: 10.2174/1570159x16666180308154646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/10/2017] [Accepted: 02/27/2018] [Indexed: 11/22/2022] Open
Abstract
Epilepsy is considered the most frequent severe neurological condition but most patients treated with medication become seizure free. The management of treatment, however, is highly empirical, mainly relying on observation. A closed-loop therapy for epilepsy would be very valuable for more efficient treatment regimens. Here we discuss monitoring treatment (therapeutic drug monitoring) and the potential developments in this field, as well as providing a review of potential biomarkers that could be used to monitor the disease activity. Finally, we consider the pharmacogenetic input in epilepsy treatment.
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Affiliation(s)
- Irene Aicua-Rapun
- Address correspondence to this author at the Department of Neuroscience, Neurology service. University Hospital of Lausanne BH07, Faculty of Biology and Medicine, University of Lausanne. Rue du Bugnon 46 CH 1011, Lausanne, Switzerland; Tel/Fax: +41213144552, +41213141290;, E-mail:
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25
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Dynamic and Sex-Specific Changes in Gonadotropin-Releasing Hormone Neuron Activity and Excitability in a Mouse Model of Temporal Lobe Epilepsy. eNeuro 2018; 5:eN-NWR-0273-18. [PMID: 30255128 PMCID: PMC6153338 DOI: 10.1523/eneuro.0273-18.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 12/28/2022] Open
Abstract
Reproductive endocrine disorders are prominent comorbidities of temporal lobe epilepsy (TLE) in both men and women. The neural mechanisms underlying these comorbidities remain unclear, but hypothalamic gonadotropin-releasing hormone (GnRH) neurons may be involved. Here, we report the first direct demonstrations of aberrant GnRH neuron function in an animal model of epilepsy. Recordings of GnRH neuron firing and excitability were made in acute mouse brain slices prepared two months after intrahippocampal injection of kainate (KA) or control saline, a well-established TLE model in which most females develop comorbid estrous cycle disruption. GnRH neurons from control females showed elevated firing and excitability on estrus compared with diestrus. By contrast, cells from KA-injected females that developed prolonged, disrupted estrous cycles (KA-long) showed the reverse pattern. Firing rates of cells from KA-injected females that maintained regular cycles (KA-regular) were not different from controls on diestrus, but were reduced on estrus. In KA-injected males, only GnRH neurons in the medial septum displayed elevated firing. In contrast to the diestrus versus estrus and sex-specific changes in firing, GnRH neuron intrinsic excitability was elevated in all KA-injected groups, indicating a role for afferent synaptic and neuromodulatory inputs in shaping overall changes in firing activity. Furthermore, KA-injected females showed cycle-stage-specific changes in circulating sex steroids on diestrus and estrus that also differed between KA-long and KA-regular groups. Together, these findings reveal that the effects of epilepsy on the neural control of reproduction are dynamic across the estrous cycle, distinct in association with comorbid estrous cycle disruption severity, and sex-specific.
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26
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Tao L, Zhang X, Duan Z, Wang Y, Liu J, Hou H, Fang Q. Sexual dysfunction and associated factors in Chinese Han women with epilepsy. Epilepsy Behav 2018; 85:150-156. [PMID: 29940378 DOI: 10.1016/j.yebeh.2018.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/28/2018] [Accepted: 06/01/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Women with epilepsy (WWE) are believed to be at risk of sexual dysfunction (SD) and face many sexual challenges because of multiple factors. This study aimed to assess the factors associated with SD in Chinese Han WWE. METHODS This cross-sectional study examined 112 married WWE in the Affiliated Hospital of Yangzhou University with focal (FE) or generalized epilepsy (GE) on antiepileptic drugs (AEDs), and 120 healthy controls without epilepsy, all of Chinese Han nationality. Data collection tools included the Chinese version of Female Sexual Function Index (FSFI), the Chinese version of Zung Self-Rating Anxiety Scale (SAS), the Chinese version of the Zung Self-Rating Depression Scale (SDS), the Chinese version of the revised Morisky Medication Adherence Scale (MMAS-8), and the Chinese version of the National Hospital Seizure Severity Scale (NHS3). Chi-square test, t-test, one-way analysis of variance (ANOVA), and binary logistic regression were used for statistical analysis. RESULTS A high rate (70.5%) of SD was detected in WWE, with 24.2% in controls. Sexual dysfunction affected all dimensions: desire (85.7%), arousal (56.3%), lubrication (47.3%), orgasm (66.1%), satisfaction (58.9%), and pain (41.1%). Elevated rates of anxiety (40.2%) and depression (33%) and poor medication adherence (31.3%) were also found in WWE. Binary logistic regression found that poor economic status (odds ratio (OR) = 13.904, 95% confidence interval (CI): 2.025-95.472, P = 0.007 and OR = 6.350, 95% CI: 1.323-30.477, P = 0.021), anxiety (OR = 1.222, 95% CI: 1.055-1.415, P = 0.007), and poor medication adherence (OR = 0.297, 95% CI: 0.124-0.707, P = 0.006) were associated with SD. CONCLUSIONS The associated factors of SD in Chinese Han WWE are multifactorial. The WWE have higher levels of anxiety, poor family economic status, and poor medication adherence. Medical professionals should not only better control seizures but also evaluate and improve patients' sexual function so as to improve the quality of life of WWE.
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Affiliation(s)
- Lihong Tao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China; Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Xinjiang Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Zuowei Duan
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Yingge Wang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Jiangbing Liu
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Hongling Hou
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
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Ogunjimi L, Yaria J, Makanjuola A, Ogunniyi A. Sexual dysfunction among Nigerian women with epilepsy. Epilepsy Behav 2018; 83:108-112. [PMID: 29684822 DOI: 10.1016/j.yebeh.2018.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/02/2018] [Accepted: 02/02/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Sexual dysfunction (SD) has been shown to be more prevalent among females with epilepsy (FWE) when compared with controls. Identified risk factors for SD among FWE include depression, antiepileptic drug (AED) type, epileptic lateralization, and temporal lobe involvement. Despite a huge population of FWE in sub-Saharan Africa and by extension Nigeria, there are limited studies on the effect of AEDs and epilepsy on sexual function among FWE in the region. We therefore studied predictors and patterns of SD among Nigerian FWE. METHOD This was a descriptive study carried out at the University College Hospital, Oyo State - a tertiary hospital in South-Western Nigeria. The Zung Self-rating Depression Scale was used to assess mood. Sexual dysfunction was measured using the Arizona Sexual Experience Scale (ASEX) questionnaire. RESULTS The frequency of clinically significant SD among FWE (35, 50.0%) was similar to that of controls (27, 38.6%; p = 0.173). However, the mean ASEX score was higher in FWE than in controls (p = 0.009). Using domains defined by the Diagnostic and Statistical Manual of Mental Disorders - 5th Edition (DSM-V), we observed that FWE had higher scores in all domains. Sexual dysfunction was also more prevalent among FWE with lesional epilepsy when compared with those with nonlesional epilepsy. Standardized beta coefficients from multiple regressions conducted suggest that age of FWE, the presence of motor weakness, and systolic blood pressure contributed to SD. SIGNIFICANCE Females with epilepsy had higher ASEX scores in all domains, with older FWE and those with lesional epilepsy more likely to have SD. Healthcare providers should pay attention to SD among FWE for improved quality of life.
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Affiliation(s)
- Luqman Ogunjimi
- Department of Internal Medicine, University College Hospital, Ibadan, Nigeria.
| | - Joseph Yaria
- Department of Internal Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Adesola Ogunniyi
- Department of Internal Medicine, University College Hospital, Ibadan, Nigeria
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Mazarati A, Galanopoulou AS. Commentary on Li et al. "Disrupted female estrous cyclicity in the intrahippocampal kainic acid mouse model of temporal lobe epilepsy". Epilepsia Open 2018; 3:131-133. [PMID: 29881794 PMCID: PMC5983120 DOI: 10.1002/epi4.12116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 11/07/2022] Open
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Amini L, Hematian M, Montazeri A, Gharegozli K. Comparing the frequency of polycystic ovary syndrome in women with and without epilepsy. J Family Med Prim Care 2018; 7:16-20. [PMID: 29915727 PMCID: PMC5958560 DOI: 10.4103/jfmpc.jfmpc_115_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders; the impact of epilepsy and antiepileptic drugs influences the function of hypothalamic–pituitary–gonadal axis and dysfunction of the endocrine system and reproductive hormones in women with epilepsy. This study was carried out with an aim of determining and comparing the frequency and intensity of the complications of the hirsutism in women with and without epilepsy in Tehran in 2016–2017. Materials and Methods: This is a cross-sectional-comparative study which was carried out on 338 women of 18–35-year-old women with and without epilepsy who were selected by continuous sampling method. Data were collected and analyzed by Chi-square statistical test. The quantity of P was considered to be 0.05 as the level of significance. Results: The results of this study indicated that there was a statistically significant difference between the two groups with and without epilepsy in terms of the frequency of some of the clinical symptoms of the PCOS and affected by it. The results of this study showed that a higher percentage of women with epilepsy were affected PCOS. In the group of epileptic patients, some of the clinical symptoms of PCOS such as hirsutism, acanthosis nigricans, disordered menstruation, and amenorrhea were higher which as a result led to an increase in the frequency of PCOS. Conclusion: As a result, epilepsy can lead to an increase in the frequency of PCOS and some other clinical symptoms.
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Affiliation(s)
- Leila Amini
- Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Hematian
- Department of Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Department of Mental Health, Health Metric Research Center, Iran Iranian Institute for Health Science Research Center, The Academic Center for Education, Tehran, Iran
| | - Korosh Gharegozli
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
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Bosak M, Słowik A, Turaj W. Menstrual disorders and their determinants among women with epilepsy. Neuropsychiatr Dis Treat 2018; 14:2657-2664. [PMID: 30349263 PMCID: PMC6188158 DOI: 10.2147/ndt.s179438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The purpose of the present study was to assess the prevalence and determinants of menstrual cycle disorders among women with epilepsy. MATERIALS AND METHODS The study included consecutive women with epilepsy who visited a university epilepsy clinic. A number of variables, including demographics, characteristics of epilepsy and its treatment, and data related to reproductive health (regularity of menstrual cycle, number of pregnancies and childbirths), were collected from medical records, seizure diaries, and a dedicated questionnaire. RESULTS The study involved 271 women with epilepsy. Focal epilepsy was diagnosed in 182 (67.2%) patients; 108 (39.8%) women had rare seizures (<1 per year), and 164 patients (60.5%) were on monotherapy. Menstrual abnormalities were found in 78 patients (28.8%). Independent variables associated with irregular cycle included younger age at onset of epilepsy (OR=0.95 per 1-year increase; P=0.008), current use of clonazepam (OR=5.36; P=0.010), and chronic use of medication(s) other than antiepileptic drug(s) (AEDs; OR=2.48; P=0.003). Childbirth rate was low in our cohort (0.50 per patient); independent predictors of being childless in studied patients included younger age, presence of menstrual disorders, and greater number of currently used AEDs. CONCLUSION Menstrual disturbances were present in 28.8% of studied women with epilepsy. Increased prevalence of menstrual abnormalities was associated with epilepsy itself (younger age at onset of epilepsy) and its treatment (ongoing use of clonazepam), as well as with chronic use of medications other than AEDs.
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Affiliation(s)
- Magdalena Bosak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland,
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland,
| | - Wojciech Turaj
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland,
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Atif M, Sarwar MR, Scahill S. The relationship between epilepsy and sexual dysfunction: a review of the literature. SPRINGERPLUS 2016; 5:2070. [PMID: 27995047 PMCID: PMC5135706 DOI: 10.1186/s40064-016-3753-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 11/26/2016] [Indexed: 12/31/2022]
Abstract
Background and objectives Regardless of the disease states that people suffer from, maintaining sexual function is an important indicator of quality of life. The objective of this review was to figure out the relationship between epilepsy, antiepileptic drugs (AEDs) and sexual dysfunction. Results In various epidemiological and clinical studies, epilepsy has been correlated with a reduction in sexual function. This sexual dysfunction is not always detected in epileptic patients until systematic efforts are put in place, as part of the assessment and treatment process. Therefore, precise evaluations of the incidence of treatment related sexual dysfunction in epileptic patients is still lacking. Conclusions This literature review concluded that sexual function is influenced by the pathophysiology of epilepsy, as well as through the use of AEDs. To maximize quality of care in patients with epilepsy and those patients with other disease states who receive AEDs, it is important to address the status of the patient’s sexual function as part of the initial routine assessment and with any treatment related follow-up. Minimizing the effects of AED related sexual dysfunction can be achieved by raising awareness among patients, providing education and training for physicians regarding sexual dysfunction and obtaining a baseline sexual history from the patient so are important recommendations. In addition, systematic studies are needed to explore the risk and mechanism of such treatment related side effects on sexual function.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Muhammad Rehan Sarwar
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Shane Scahill
- School of Management, Massey University, Auckland, New Zealand
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Harden CL, Pennell PB, French JA, Davis A, Lau C, Llewellyn N, Kaufman B, Bagiella E, Kirshenbaum A. Anti-mullerian hormone is higher in seizure-free women with epilepsy compared to those with ongoing seizures. Epilepsy Res 2016; 127:66-71. [PMID: 27565413 DOI: 10.1016/j.eplepsyres.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/13/2016] [Accepted: 08/06/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine if anti-mullerian hormone (AMH), a neuroactive peptide hormone and a measure of ovarian reserve, is different between women with epilepsy (WWE) and healthy controls (HC) seeking pregnancy and to evaluate epilepsy-related factors associated with AMH concentrations. METHODS Subjects were participants in Women with Epilepsy: Pregnancy Outcomes and Deliveries (WEPOD), a multi-center prospective, observational cohort study evaluating fecundity in WWE compared to HC, ages 18-40 years. WWE were divided into a Sz+ group or a Sz- group, dependent on whether they had seizures within the 9 months prior to enrollment. Serum was collected, and AMH concentrations were measured as an exploratory analysis. Linear and logistic regression models were used to assess associations and control for covariates. RESULTS Serum AMH concentrations were measured in 72 out of 90 enrolled WWE and 97 out of 109 HC; the remaining subjects became pregnant before serum was obtained. Thirty WWE were in the Sz+ group and 40 in the Sz- group (retrospective seizure information was missing for two). All AMH concentrations were within the range, however, the normal inverse correlation between age and AMH was present in the HC and in the Sz- groups, but was lacking in the Sz+ group. Mean AMH concentration was higher in the Sz- group (3982pg/ml (SD+/-2452)) compared to the Sz+ group of WWE (2776pg/ml (SD+/-2308)) and HCs (3241 (SD±2647)). All values were within the expected range for age. In WWE, by linear regression, after controlling for age and BMI, seizure occurrence remained associated with AMH (p=0.025). In the prospective phase of the study, AMH concentrations were also associated with seizure occurrence during the menstrual cycle in which the serum sample was obtained (p=0.012). Antiepileptic drugs and other epilepsy factors were not associated with AMH concentrations. When analyzing the Sz- WWE group and the HC group by linear regression with AMH as the dependent variable, after controlling for age and BMI, the association with AMH was also present (p=0.017). AMH concentrations of the Sz+ group and HCs did not differ. SIGNIFICANCE In this exploratory analysis, seizure freedom was associated with higher AMH concentrations compared to women with ongoing seizures and to HCs. Future studies should further investigate the mechanism of the association of AMH with seizure occurrence, whether AMH could have a direct seizure-protective neuroactive hormone effect, as well as implications of AMH concentrations as a biomarker for ovarian reserve in women with epilepsy.
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Affiliation(s)
- Cynthia L Harden
- Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY, 11029, USA.
| | - Page B Pennell
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
| | | | - Anne Davis
- Columbia University Medical Center, 630 W 168th St, New York, NY, 10032, USA.
| | - Connie Lau
- Northwell Health, 611 Northern Boulevard, Great Neck, NY, 11021, USA.
| | - Nichelle Llewellyn
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
| | - Benjamin Kaufman
- NYU School of Medicine, 462 1st Avenue, New York, NY, 10016, USA.
| | - Emilia Bagiella
- Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY, 11029, USA.
| | - Ariel Kirshenbaum
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
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Rösing B. Neurogonadale Interaktionen bei Frauen mit Epilepsie. GYNAKOLOGISCHE ENDOKRINOLOGIE 2015. [DOI: 10.1007/s10304-015-0029-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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D'Amour J, Magagna-Poveda A, Moretto J, Friedman D, LaFrancois JJ, Pearce P, Fenton AA, MacLusky NJ, Scharfman HE. Interictal spike frequency varies with ovarian cycle stage in a rat model of epilepsy. Exp Neurol 2015; 269:102-19. [PMID: 25864929 PMCID: PMC4446145 DOI: 10.1016/j.expneurol.2015.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/27/2014] [Accepted: 04/02/2015] [Indexed: 01/31/2023]
Abstract
In catamenial epilepsy, seizures exhibit a cyclic pattern that parallels the menstrual cycle. Many studies suggest that catamenial seizures are caused by fluctuations in gonadal hormones during the menstrual cycle, but this has been difficult to study in rodent models of epilepsy because the ovarian cycle in rodents, called the estrous cycle, is disrupted by severe seizures. Thus, when epilepsy is severe, estrous cycles become irregular or stop. Therefore, we modified kainic acid (KA)- and pilocarpine-induced status epilepticus (SE) models of epilepsy so that seizures were rare for the first months after SE, and conducted video-EEG during this time. The results showed that interictal spikes (IIS) occurred intermittently. All rats with regular 4-day estrous cycles had IIS that waxed and waned with the estrous cycle. The association between the estrous cycle and IIS was strong: if the estrous cycles became irregular transiently, IIS frequency also became irregular, and when the estrous cycle resumed its 4-day pattern, IIS frequency did also. Furthermore, when rats were ovariectomized, or males were recorded, IIS frequency did not show a 4-day pattern. Systemic administration of an estrogen receptor antagonist stopped the estrous cycle transiently, accompanied by transient irregularity of the IIS pattern. Eventually all animals developed severe, frequent seizures and at that time both the estrous cycle and the IIS became irregular. We conclude that the estrous cycle entrains IIS in the modified KA and pilocarpine SE models of epilepsy. The data suggest that the ovarian cycle influences more aspects of epilepsy than seizure susceptibility.
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Affiliation(s)
- James D'Amour
- The Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Bldg. 35, Orangeburg, NY 10962, USA; Cantonal Hospital of Basel, Land Institute of Pathology, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland; Sackler Program in Biomedical Sciences, New York University Langone Medical Center, 550 First Ave., New York, NY 10016, USA
| | - Alejandra Magagna-Poveda
- Cantonal Hospital of Basel, Land Institute of Pathology, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
| | - Jillian Moretto
- The Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Bldg. 35, Orangeburg, NY 10962, USA
| | - Daniel Friedman
- The Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Bldg. 35, Orangeburg, NY 10962, USA; Comprehensive Epilepsy Center, New York University Langone Medical Center, 334 34th St., New York, NY 10016, USA
| | - John J LaFrancois
- The Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Bldg. 35, Orangeburg, NY 10962, USA
| | - Patrice Pearce
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Andre A Fenton
- Center for Neural Science, New York University, 4 Washington Place, New York, NY 10003, USA
| | - Neil J MacLusky
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, 50 Stone Rd, Guelph, ON N1G 2W1, Canada
| | - Helen E Scharfman
- The Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Bldg. 35, Orangeburg, NY 10962, USA; Department of Child & Adolescent Psychiatry, Physiology & Neuroscience, and Psychiatry, New York University Langone Medical Center, One Park Ave, New York, NY 10016, USA.
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Taubøll E, Heuser K, Sveberg L, Svalheim S. Experimental models for the study of hormonal changes in epilepsy. ZEITSCHRIFT FUR EPILEPTOLOGIE 2015. [DOI: 10.1007/s10309-015-0001-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Taubøll E, Sveberg L, Svalheim S. Interactions between hormones and epilepsy. Seizure 2015; 28:3-11. [PMID: 25765693 DOI: 10.1016/j.seizure.2015.02.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/08/2015] [Accepted: 02/12/2015] [Indexed: 11/18/2022] Open
Abstract
There is a complex, bidirectional interdependence between sex steroid hormones and epilepsy; hormones affect seizures, while seizures affect hormones thereby disturbing reproductive endocrine function. Both female and male sex steroid hormones influence brain excitability. For the female sex steroid hormones, progesterone and its metabolites are anticonvulsant, while estrogens are mainly proconvulsant. The monthly fluctuations in hormone levels of estrogen and progesterone are the basis for catamenial epilepsy described elsewhere in this issue. Androgens are mainly anticonvulsant, but the effects are more varied, probably because of its metabolism to, among others, estradiol. The mechanisms for the effects of sex steroid hormones on brain excitability are related to both classical, intracellularly mediated effects, and non-classical membrane effects due to binding to membrane receptors. The latter are considered the most important in relation to epilepsy. The different sex steroids can also be further metabolized within the brain to different neurosteroids, which are even more potent with regard to their effect on excitability. Estrogens potentiate glutamate responses, primarily by potentiating NMDA receptor activity, but also by affecting GABA-ergic mechanisms and altering brain morphology by increasing dendritic spine density. Progesterone and its main metabolite 5α-pregnan-3α-ol-20-one (3α-5α-THP) act mainly to enhance postsynaptic GABA-ergic activity, while androgens enhance GABA-activated currents. Seizures and epileptic discharges also affect sex steroid hormones. There are close anatomical connections between the temporolimbic system and the hypothalamus controlling the endocrine system. Several studies have shown that epileptic activity, especially mediated through the amygdala, alters reproductive function, including reduced ovarian cyclicity in females and altered sex steroid hormone levels in both genders. Furthermore, there is an asymmetric activation of the hypothalamus with unilateral amygdala seizures. This may, again, be the basis for the occurrence of different reproductive endocrine disorders described for patients with left-sided or right-sided temporal lobe epilepsy.
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Affiliation(s)
- Erik Taubøll
- Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Line Sveberg
- Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Sigrid Svalheim
- Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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Luef G, Madersbacher H. Sexual dysfunction in patients with epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:383-94. [DOI: 10.1016/b978-0-444-63247-0.00022-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Koppel BS, Harden CL. Gender issues in the neurobiology of epilepsy: A clinical perspective. Neurobiol Dis 2014; 72 Pt B:193-7. [DOI: 10.1016/j.nbd.2014.08.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023] Open
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Pohl A, Cassidy S, Auyeung B, Baron-Cohen S. Uncovering steroidopathy in women with autism: a latent class analysis. Mol Autism 2014; 5:27. [PMID: 24717046 PMCID: PMC4022124 DOI: 10.1186/2040-2392-5-27] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/10/2014] [Indexed: 11/30/2022] Open
Abstract
Background Prenatal exposure to increased androgens has been implicated in both polycystic ovary syndrome (PCOS) and autism spectrum conditions (ASC), suggesting that PCOS may be increased among women with ASC. One study suggested elevated steroidopathic symptoms (‘steroidopathy’) in women with ASC. As the symptoms are not independent, we conducted a latent class analysis (LCA). The objectives of the current study are: (1) to test if these findings replicate in a larger sample; and (2) to use LCA to uncover affected clusters of women with ASC. Methods We tested two groups of women, screened using the Autism Spectrum Quotient - Group 1: n = 415 women with ASC (mean age 36.39 ± 11.98 years); and Group 2: n = 415 controls (mean age 39.96 ± 11.92 years). All participants completed the Testosterone-related Medical Questionnaire online. A multiple-group LCA was used to identify differences in latent class structure between women with ASC and controls. Results There were significant differences in frequency of steroid-related conditions and symptoms between women with ASC and controls. A two-class semi-constrained model best fit the data. Based on response patterns, we identified the classes as ‘Typical’ and ‘Steroidopathic’. The prevalence of the ‘Steroidopathic’ class was significantly increased within the ASC group (ΔG2 = 15, df =1, P = 0.0001). In particular, we confirmed higher frequencies of epilepsy, amenorrhea, dysmenorrhea, severe acne, gender dysphoria, and transsexualism, and differences in sexual preference in women with ASC. Conclusions Women with ASC are at increased risk for symptoms and conditions linked to steroids. LCA revealed this steroidopathy despite the apparent underdiagnosis of PCOS.
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Affiliation(s)
- Alexa Pohl
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge CB2 8AH, UK
| | - Sarah Cassidy
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge CB2 8AH, UK ; Department of Psychology and Behavioural Sciences, Coventry University, James Starley Building, Cox Street, Coventry CV1 5LW, UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge CB2 8AH, UK ; Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9 AD, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge CB2 8AH, UK ; CLASS Clinic, Cambridgeshire and Peterborough Mental Health Foundation NHS Trust, The Chitra Sethia Autism Centre, The Gatehouse, Fulborn Hospital, Fulborn, Cambridge CB21 5EF, UK
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Abstract
Individuals with epilepsy experience a number of sex-specific problems. In women, pregnancy and delivery are obvious issues, fertility problems are more often encountered and they also seem to have a higher frequency of sexual problems. A large number of women with epilepsy experience seizure exacerbation in relation to the menstrual cycle and have higher frequencies of menstrual disturbances and polycystic ovaries. Cosmetic problems affecting skin, hair or weight may also be drug induced. The use of antiepileptic drugs may influence the effect of contraceptives leading to unplanned pregnancies and contraceptives may affect the serum levels of antiepileptic drugs. The care of pregnant women with epilepsy requires attention to a number of guidelines and close cooperation between neurologist and gynecologist is recommended. Although the majority of the women with epilepsy experience normal pregnancies and deliveries, their children have a higher risk of birth defects. At menopause, their seizure pattern may change and some antiepileptic drugs may increase the risk of osteoporosis. The optimal treatment of women with epilepsy should take into account these gender-specific issues in the different stages of life.
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Affiliation(s)
- Line Sveberg Røste
- Rikshospitalet-Radiumhospitalet Medical Center, Department of Neurology, Division for Clinical Neuroscience, 0027 Oslo, Norway.
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Xiaotian X, Hengzhong Z, Yao X, Zhipan Z, Daoliang X, Yumei W. Effects of antiepileptic drugs on reproductive endocrine function, sexual function and sperm parameters in Chinese Han men with epilepsy. J Clin Neurosci 2013; 20:1492-7. [DOI: 10.1016/j.jocn.2012.11.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 11/13/2012] [Accepted: 11/18/2012] [Indexed: 11/26/2022]
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Ramesha KN, Radhakrishnan A, Jiayaspathi A, Padickaparambal S, Alexander A, Unnikrishnan JP, Sarma PS, Radhakrishnan K. Sexual desire and satisfaction after resective surgery in patients with mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Behav 2012; 25:374-80. [PMID: 23103313 DOI: 10.1016/j.yebeh.2012.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/14/2012] [Accepted: 07/17/2012] [Indexed: 11/16/2022]
Abstract
Utilizing a questionnaire, we inquired about the self-perceived sexual behavior of 50 married males with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) before and after anterior temporal lobectomy (ATL) and compared the results with those of 50 age-matched healthy married males. The sexual desire and satisfaction of the patients were poor when compared to the controls. Although a majority of the sexual domains improved following ATL, even after a median duration of five years, the sexual status of the patients did not match with that of the controls. Those who, after ATL, were seizure free, had one or no antiepileptic drug (AED) and had an EEG without epileptiform abnormalities achieved a better sexual outcome. We conclude that sexual dysfunction is frequent in male patients with MTLE-HS. They require preoperative assessment to identify their sexual inadequacies as well as counseling about the expected post-ATL sexual outcome. Discontinuation of enzyme-inducing AEDs facilitates post-ATL improvement in sexual function.
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Affiliation(s)
- Kallakatta N Ramesha
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Zhou JQ, Zhou LM, Chen LJ, Han JD, Wang Q, Fang ZY, Chen ZY, Ling S. Polycystic ovary syndrome in patients with epilepsy: a study in 102 Chinese women. Seizure 2012; 21:729-33. [PMID: 22944116 DOI: 10.1016/j.seizure.2012.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/07/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The incidence of polycystic ovary syndrome (PCOS) increases in women with epilepsy (WWE), which appears to vary with ethnicity. This study was conducted to determine the incidence and risk factors of PCOS in Chinese WWE. METHODS The study was carried out in 102 of 139 Chinese WWE at reproductive ages, with 32 receiving valproic acid (VPA), 40 receiving other antiepileptic drugs (AEDs), and 30 without AEDs therapy. PCOS was defined as having 2 or more of the following components: polycystic ovaries, hyperandrogenism, and amenorrhoea or oligomenorrhoea (a/oligomenorrhoea). RESULTS One or more isolated components of PCOS were found in 56 (54.9%) patients, with 29 (28.4%) having polycystic ovaries, 20 (19.6%) with a/oligomenorrhea, 7 (6.9%) with hyperandrogenism, and 13 (12.7%) with defined PCOS. Their average age at the start of seizure was 13.8±6.5 years, younger than that of patients without these disorders (16.9±8.6 years, p<0.05). VPA therapy increased the incidence of PCOS (11/32, 34.4%), in addition to increased blood levels of testosterone and luteinizing hormone (LH) as well as LH to FSH (follicle-stimulating hormone) ratio. No significant relationship was found between the incidence of PCOS and the type, duration, or frequency of seizures in these WWE. CONCLUSION There is an increased incidence of PCOS in Chinese WWE at reproductive ages, by more than 2 times of that in the general population. Risk factors include seizures starting at a young age and VPA therapy.
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Affiliation(s)
- Jue-Qian Zhou
- Department of Neurology, First Affiliated Hospital, Sun Yat-Set University, Guangzhou, Guangdong 510080, China.
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Gaitatzis A, Sisodiya SM, Sander JW. The somatic comorbidity of epilepsy: A weighty but often unrecognized burden. Epilepsia 2012; 53:1282-93. [DOI: 10.1111/j.1528-1167.2012.03528.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Pack AM, Reddy DS, Duncan S, Herzog A. Neuroendocrinological aspects of epilepsy: important issues and trends in future research. Epilepsy Behav 2011; 22:94-102. [PMID: 21454133 DOI: 10.1016/j.yebeh.2011.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 02/10/2011] [Indexed: 01/10/2023]
Abstract
Neuroendocrine research in epilepsy focuses on the interface among neurology, endocrinology, gynecology/andrology and psychiatry as it pertains to epilepsy. There are clinically important reciprocal interactions between hormones and the brain such that neuroactive hormones can modulate neuronal excitability and seizure occurrence while epileptiform discharges can disrupt hormonal secretion and promote the development of reproductive disorders. An understanding of these interactions and their mechanisms is important to the comprehensive management of individuals with epilepsy. The interactions are relevant not only to the management of seizure disorder but also epilepsy comorbidities such as reproductive dysfunction, hyposexuality and emotional disorders. This review focuses on some of the established biological underpinnings of the relationship and their clinical relevance. It identifies gaps in our knowledge and areas of promising research. The research has led to ongoing clinical trials to develop hormonal therapies for the treatment of epilepsy. The review also focuses on complications of epilepsy treatment with antiepileptic drugs. Although antiepileptic drugs have been the mainstay of epilepsy treatment, they can also have some adverse effects on sexual and reproductive function as well as bone density. As longevity increases, the prevention, diagnosis and treatment of osteoporosis becomes an increasingly more important topic, especially for individuals with epilepsy. The differential effects of antiepileptic drugs on bone density and their various mechanisms of action are reviewed and some guidelines and future directions for prevention of osteoporosis and treatment are presented.
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Affiliation(s)
- Alison M Pack
- Columbia Comprehensive Epilepsy Center, Columbia University Medical Center, New York, NY, USA
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Pack AM, Morrell MJ, McMahon DJ, Shane E. Normal vitamin D and low free estradiol levels in women on enzyme-inducing antiepileptic drugs. Epilepsy Behav 2011; 21:453-8. [PMID: 21704565 PMCID: PMC3156279 DOI: 10.1016/j.yebeh.2011.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/27/2011] [Accepted: 05/06/2011] [Indexed: 11/16/2022]
Abstract
Relationships between reproductive hormone levels, bone turnover marker levels, bone mineral density, and rates of bone loss were evaluated in premenopausal women with epilepsy taking enzyme-inducing antiepileptic drugs (EIAEDs: phenytoin or carbamazepine) or lamotrigine. Calciotropic and reproductive hormone levels, bone turnover marker levels, and bone mineral density were measured at baseline and 1 year. Bone mineral density did not differ between groups. Serum calcium (P<0.001) and estrone (P<0.001) levels were lower in the EIAED group. Sex hormone-binding globulin levels were higher (P<0.001) and percentage free estradiol levels were lower (P<0.001) in the EIAED group. We detected no relationship between bone mineral density change and calciotropic hormone or bone turnover marker levels. Women with higher sex hormone-binding globulin and lower free estradiol levels sustained more bone loss at the total hip (P=0.04 and P=0.02) and a trend toward more bone loss at the lumbar spine (P=0.07 and P=0.08). These findings suggest that lower estrogen levels may contribute to bone loss in premenopausal women with epilepsy.
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Verrotti A, Loiacono G, Laus M, Coppola G, Chiarelli F, Tiboni GM. Hormonal and reproductive disturbances in epileptic male patients: Emerging issues. Reprod Toxicol 2011; 31:519-27. [DOI: 10.1016/j.reprotox.2011.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 01/12/2011] [Accepted: 02/14/2011] [Indexed: 01/23/2023]
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Verrotti A, D'Egidio C, Mohn A, Coppola G, Parisi P, Chiarelli F. Antiepileptic drugs, sex hormones, and PCOS. Epilepsia 2011; 52:199-211. [PMID: 21204821 DOI: 10.1111/j.1528-1167.2010.02897.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Reproductive endocrine dysfunction in women with epilepsy is an important issue, and in recent years there is growing evidence to support the effect on sex hormones of both epilepsy per se and various antiepileptic drugs (AEDs). Focal epileptic discharges from the temporal lobe may have a direct influence on the function of the hypothalamic-pituitary axis, thereby altering the release of sex steroid hormones. The role of laterality and severity of epilepsy is still conflicting. The use of the liver enzyme-inducing AEDs--such as phenobarbital, phenytoin, and carbamazepine--can increase serum sex hormone-binding globulin concentrations, leading to diminished bioactivity of testosterone (T) and estradiol. Valproic acid, an enzyme inhibitor, has been associated with the occurrence of reproductive endocrine disorders characterized by high serum T, free androgen index, androstenedione, dehydroepiandrosterone sulfate concentrations, and with polycystic changes in ovaries and menstrual disorders. A better understanding of the effects of AEDs on sex hormones is key to selecting the appropriate AEDs and is crucial for reproductive health in female patients.
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Abstract
Postictal increases in prolactin (PRL), luteinizing hormone, and follicle-stimulating hormone have been recorded in patients with both generalized tonic-clonic and partial seizures. Elevations of PRL and luteinizing hormone were seen immediately and at 20 minutes after generalized tonic-clonic seizures in male and female patients. Usually, PRL blood levels return to normal values within 1 hour. Previous studies have evaluated the utility of the transient increases in PRL, neuron-specific enolase, and S-100 protein as markers of epileptic seizures in children and adults. The conclusion was that measurement of serum PRL is a reliable confirmatory test in the presence of a seizure, but only modestly effective as a screening test for suspected seizures. Temporal lobe epilepsy is associated with abnormalities of reproductive physiology, but the mechanisms of hormonal dysregulation are not clear. A direct influence of epilepsy on the reproductive endocrine system is suggested by acute changes in PRL and gonadotropin levels following generalized and partial seizures, pointing to a possible relationship between temporolimbic epileptiform discharges and particular reproductive endocrine disorders. Chronic effects of the epileptic state and the acute impact of seizures could alter hypothalamic function, as indicated by downstream pulsatile secretion of luteinizing hormone. The brain controls reproductive function primarily through hypothalamic regulation of pituitary secretion regions of the hypothalamus. These are areas that are involved in the regulation, production, and secretion of gonadotropin-releasing hormone and receive extensive direct connections from the cerebral hemispheres, especially from temporolimbic structures, most notably from the amygdala, that are commonly involved in temporal lobe epilepsy. Significant relationships have been uncovered through which ictal and postictal effects of seizures and epilepsy may influence the function of this complex neuroendocrine system.
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Affiliation(s)
- Gerhard Luef
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
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Cansu A. Antiepileptic drugs and hormones in children. Epilepsy Res 2010; 89:89-95. [DOI: 10.1016/j.eplepsyres.2009.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 09/04/2009] [Accepted: 09/15/2009] [Indexed: 11/28/2022]
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