1
|
Mascarenhas C, Sousa ACA, Rato L. Effects of Pharmaceutical Substances with Obesogenic Activity on Male Reproductive Health. Int J Mol Sci 2024; 25:2324. [PMID: 38397000 PMCID: PMC10889417 DOI: 10.3390/ijms25042324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/28/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Obesogens have been identified as a significant factor associated with increasing obesity rates, particularly in developed countries. Substances with obesogenic traits are prevalent in consumer products, including certain pharmaceuticals. Specific classes of pharmaceuticals have been recognized for their ability to induce weight gain, often accompanied by hormonal alterations that can adversely impact male fertility. Indeed, research has supplied evidence underscoring the crucial role of obesogens and therapeutic agents in the normal functioning of the male reproductive system. Notably, sperm count and various semen parameters have been closely linked to a range of environmental and nutritional factors, including chemicals and pharmacological agents exhibiting obesogenic properties. This review aimed to explore studies focused on analyzing male fertility parameters, delving into the intricacies of sperm quality, and elucidating the direct and adverse effects that pharmacological agents may have on these aspects.
Collapse
Affiliation(s)
- Caio Mascarenhas
- School of Health, Polytechnic Institute of Guarda, 6300-035 Guarda, Portugal;
| | - Ana C. A. Sousa
- Department of Biology, School of Science and Technology, University of Évora, 7006-554 Évora, Portugal;
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-671 Évora, Portugal
| | - Luís Rato
- School of Health, Polytechnic Institute of Guarda, 6300-035 Guarda, Portugal;
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal
| |
Collapse
|
2
|
Echevarria-Cooper DM, Kearney JA. Evaluating the interplay between estrous cyclicity and flurothyl-induced seizure susceptibility in Scn2a K1422E mice. MICROPUBLICATION BIOLOGY 2023; 2023:10.17912/micropub.biology.000850. [PMID: 38162411 PMCID: PMC10757737 DOI: 10.17912/micropub.biology.000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/30/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
Recently, we demonstrated that Scn2a K1422E female mice showed a distinct distribution of flurothyl-induced seizure thresholds. To evaluate whether the estrous cycle contributes to this effect, estrous cycle monitoring was performed in mice that had undergone ovariectomy, sham surgery, or no treatment prior to seizure induction. Ovariectomy did not affect the non-unimodal distribution of flurothyl seizure thresholds observed in Scn2a K1422E females. Additionally, seizure thresholds were not associated with estrous cycle stage in mice that underwent sham surgery or in non-surgerized (intact) mice. Interestingly, intact Scn2a K1422E females showed evidence of disrupted estrous cyclicity, an effect not previously described in a genetic epilepsy model.
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Echevarria-Cooper DM, Kearney JA. Evaluating the interplay between estrous cyclicity and induced seizure susceptibility in Scn2aK1422E mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.27.538584. [PMID: 37163100 PMCID: PMC10168397 DOI: 10.1101/2023.04.27.538584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pathogenic variants in SCN2A are associated with a range of neurodevelopmental disorders (NDD). SCN2A-related NDD show wide phenotypic heterogeneity, suggesting that modifying factors must be considered in order to properly elucidate the mechanisms of pathogenic variants. Recently, we characterized neurological phenotypes in a mouse model of the variant SCN2A-p.K1422E. We demonstrated that heterozygous Scn2aK1422E female mice showed a distinct, reproducible distribution of flurothyl-induced seizure thresholds. Women with epilepsy often show a cyclical pattern of altered seizure susceptibility during specific phases of the menstrual cycle which can be attributed to fluctuations in hormones and corresponding changes in neurosteroid levels. Rodent models have been used extensively to examine the relationship between the estrous (menstrual) cycle, steroid hormones, and seizure susceptibility. However, the effects of the estrous cycle on seizure susceptibility have not been evaluated in the context of an epilepsy-associated genetic variant. To determine whether the estrous cycle affects susceptibility to flurothyl-induced seizures in Scn2aK1422E female mice, estrous cycle monitoring was performed in mice that had undergone ovariectomy (OVX), sham surgery, or no treatment prior to seizure induction. Removing the influence of circulating sex hormones via OVX did not affect the non-unimodal distribution of flurothyl seizure thresholds observed in Scn2aK1422E females. Additionally, flurothyl seizure thresholds were not associated with estrous cycle stage in mice that underwent sham surgery or were untreated. These data suggest that variation in Scn2aK1422E flurothyl seizure threshold is not significantly influenced by the estrous cycle and, by extension, fluctuations in ovarian hormones. Interestingly, untreated Scn2aK1422E females showed evidence of disrupted estrous cyclicity, an effect not previously described in a genetic epilepsy model. This unexpected result highlights the importance of considering sex specific effects and the estrous cycle in support of more inclusive biomedical research.
Collapse
Affiliation(s)
- Dennis M. Echevarria-Cooper
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Northwestern University Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL 60611, USA
| | - Jennifer A. Kearney
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Northwestern University Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL 60611, USA
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Carpenter JC, Lignani G. Sex on the Brain: Reproductive Comorbidities in Temporal Lobe Epilepsy. Epilepsy Curr 2023; 23:58-60. [PMID: 36923330 PMCID: PMC10009125 DOI: 10.1177/15357597221135717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Increased GABA Transmission to GnRH Neurons After Intrahippocampal Kainic Acid Injection in Mice Is Sex-Specific and Associated With Estrous Cycle Disruption Ingram RJ, Leverton LK, Daniels VC, Li J, Christian-Hinman CA. Neurobiol Dis . 2022;172:105822. doi:10.1016/j.nbd.2022.105822 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.
Collapse
Affiliation(s)
- Jenna C Carpenter
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London
| | - Gabriele Lignani
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Octaviana F, Sumapraja K, Wiratman W, Indrawati LA, Budikayanti A. Characteristics of menstrual disorders and reproductive hormones in women with epilepsy at an Indonesian national referral hospital. Front Neurol 2022; 13:964761. [PMID: 36204000 PMCID: PMC9531022 DOI: 10.3389/fneur.2022.964761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveMenstrual disorders are more common in women with epilepsy than in those without epilepsy. This study aimed to examine the characteristics of reproductive function in women with epilepsy at an Indonesian national referral hospital.MethodsA case-control study was conducted from March 2020 to March 2021. Women with and without epilepsy aged ≥18 years were enrolled. All women were premenopausal before epilepsy diagnosis. Data on demographic characteristics, menstrual profiles, epileptic syndrome, seizure type, seizure frequency, etiology, localization, and anticonvulsant medication were collected. Hormone levels (follicle stimulating hormone, luteinizing hormone, prolactin, and estradiol) were measured.ResultsA total of 72 women with and 50 without epilepsy (controls) were included. Dysmenorrhea was more common in women with epilepsy than in those without (59.7 vs. 20%, p < 0.001; odds ratio: 5.931 [95% confidence interval: 2.566–13.709]). Marriage rates were higher in women without epilepsy (82 vs. 45.8%, p < 0.001). No difference was found in hormone levels between the groups. The frequency of seizures was associated with prolactin and estradiol levels (p < 0.001). Polytherapy with clobazam was associated with menstrual cycle regularity. In women with epilepsy with menstrual disorders, valproic acid was associated with higher estradiol levels (p = 0.001) and lamotrigine with lower follicle stimulating hormone levels (p = 0.008).SignificanceWomen with epilepsy experienced more dysmenorrhea. A higher frequency of seizures associated with lower prolactin and estradiol levels. Polytherapy with clobazam was associated with irregular menstrual cycles, while valproic acid and lamotrigine was associated with estradiol and follicle stimulating hormone levels.
Collapse
Affiliation(s)
- Fitri Octaviana
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Neurology, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
- *Correspondence: Fitri Octaviana
| | - Kanadi Sumapraja
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Winnugroho Wiratman
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Neurology, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Luh Ari Indrawati
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Neurology, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Astri Budikayanti
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Neurology, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| |
Collapse
|
9
|
Hophing L, Kyriakopoulos P, Bui E. Sex and gender differences in epilepsy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:235-276. [PMID: 36038205 DOI: 10.1016/bs.irn.2022.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex and gender differences in epilepsy are important influencing factors in epilepsy care. In epilepsy, the hormonal differences between the sexes are important as they impact specific treatment considerations for patients at various life stages particularly during early adulthood with establishment of the menstrual cycle, pregnancy, perimenopause and menopause. Choice of antiseizure medication may have direct consequences on hormonal cycles, hormonal contraception, pregnancy and fetal risk of major congenital malformation. Conversely hormones whether intrinsic or extrinsically administered may have direct impact on antiseizure medications and seizure control. This chapter explores these important influences on the management of persons with epilepsy.
Collapse
Affiliation(s)
- Lauren Hophing
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada
| | | | - Esther Bui
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada.
| |
Collapse
|
10
|
Li J, Christian-Hinman CA. Epilepsy-associated increase in gonadotropin-releasing hormone neuron firing in diestrous female mice is independent of chronic seizure burden severity. Epilepsy Res 2022; 184:106948. [PMID: 35690025 PMCID: PMC10416707 DOI: 10.1016/j.eplepsyres.2022.106948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 12/21/2022]
Abstract
Reproductive endocrine disorders are common comorbidities of temporal lobe epilepsy (TLE). Our previous studies using the intrahippocampal kainic acid (IHKA) mouse model of TLE demonstrated that many females show prolonged estrous cycles and hypothalamic gonadotropin-releasing hormone (GnRH) neurons exhibit elevated firing during diestrus. However, it is unknown whether the degree of change in GnRH neuron activity is dependent on epilepsy severity. Here, we used 24/7 in vivo electroencephalography (EEG) and in vitro electrophysiological recordings in acute brain slices to assess GnRH neuron firing in relation to chronic seizure burden in diestrous female mice at two months after IHKA injection. We found that percentage of time in seizure activity in the 24 h prior to slice preparation is an accurate proxy of overall seizure burden. Firing rates of GnRH neurons from EEG-recorded IHKA mice were increased in comparison to controls, but no relationships were found between GnRH neuron firing and seizure burden measured in vivo. The independence of GnRH neuron firing rate in relation to seizure burden was unaffected by GnRH neuron soma location or estrous cycle length. Furthermore, GnRH neuron firing rates were not yet different from control values when measured 1 month after injection, when epileptogenesis is already complete in IHKA mice. These findings indicate that the severity of epilepsy and the degree of downstream disruption to GnRH neuron activity are independent, suggesting that susceptibility to reproductive endocrine comorbidities is driven by other risk factors.
Collapse
Affiliation(s)
- Jiang Li
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| | - Catherine A Christian-Hinman
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; Department of Molecular and Integrative Physiology, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA; Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA.
| |
Collapse
|
11
|
Parekh K, Kravets HD, Spiegel R. Special Considerations in the Management of Women with Epilepsy in Reproductive Years. J Pers Med 2022; 12:jpm12010088. [PMID: 35055403 PMCID: PMC8781280 DOI: 10.3390/jpm12010088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/23/2021] [Accepted: 01/05/2022] [Indexed: 12/07/2022] Open
Abstract
Anti-seizure medications (ASMs) fail to prevent seizure recurrence in more than 30% of patients with epilepsy. The treatment is more difficult in premenopausal women with epilepsy (WWE) because changes in plasma estrogen and progesterone concentrations during the menstrual cycle often affect seizure frequency and intensity. Interactions between enzyme-inducin ASMs and hormonal contraceptives can lead to both a loss of seizure control and failure of contraception. Significant changes in the function of the liver and kidneys during pregnancy can accelerate metabolism and elimination of ASMs, causing breakthrough seizures. In addition, the teratogenic, cognitive, and psychological effects of ASMs on potential offspring have to be considered when choosing the best ASM regimen. Therefore, aspecialized approach is necessary for the treatment of premenopausal WWE.
Collapse
|
12
|
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.
Collapse
|
13
|
Karakaya FB, Yavuz M, Sirvanci S. Histological analysis of the effects of thymoquinone on testicular damage in pentylenetetrazole-induced temporal lobe epilepsy model. Andrologia 2021; 53:e14130. [PMID: 34414592 DOI: 10.1111/and.14130] [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: 03/04/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022] Open
Abstract
In this study, it was aimed to investigate possible ameliorating effects of thymoquinone on testicular damage in an epilepsy model. Adult male Wistar rats were divided into 4 groups. The animals in sham-operated groups were given saline or thymoquinone (s.c.); and the animals in pentylenetetrazole (PTZ) group were applied PTZ. The animals in PTZ+thymoquinone group were given thymoquinone (i.p) for 6 days after applying PTZ. Hematoxylin-eosin, periodic acid-Schiff and TUNEL staining and PCNA, StAR, inhibin β-B immunohistochemistry and ZO-1 immunofluorescence methods were applied. Staining intensity and cell numbers were determined. Degeneration of seminiferous tubules was observed in PTZ group. Most of the tubules showed normal morphology in the PTZ+thymoquinone group. Apoptotic cell index was found to be increased and proliferative index decreased in PTZ group. Thymoquinone administration decreased apoptotic index and increased proliferation index. In PTZ group, ZO-1, StAR and inhibin β-B immunohistochemical staining intensity was observed to be decreased and after thymoquinone application, ZO-1 was increased. StAR and inhibin β-B-positive cell numbers were decreased in PTZ group and increased in the PTZ +thymoquinone group. In this study, it was observed that PTZ-induced epileptic seizures caused testicular damage in the rat and thymoquinone ameliorated these effects.
Collapse
Affiliation(s)
- Fatma Bedia Karakaya
- Department of Histology and Embryology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Melis Yavuz
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Serap Sirvanci
- Department of Histology and Embryology, School of Medicine, Marmara University, Istanbul, Turkey
| |
Collapse
|
14
|
Anwar MJ, Alenezi SK, Mahmood D, Azam F, Alharbi KS. An insight into the implications of estrogen deficiency and transforming growth factor β in antiepileptic drugs-induced bone loss. Eur J Pharmacol 2021; 907:174313. [PMID: 34245750 DOI: 10.1016/j.ejphar.2021.174313] [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: 02/04/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022]
Abstract
There have been a number of reports that chronic antiepileptic drug (AEDs) therapy is associated with abnormal bone and calcium metabolism, osteoporosis/osteomalacia, and increased risk of fractures. Bony adverse effects of long term antiepileptic drug therapy have been reported for more than four decades but the exact molecular mechanism is still lacking. Several mechanisms have been proposed regarding AEDs induced bone loss; Hypovitaminosis D, hyperparathyroidism, estrogen deficiency, calcitonin deficiency. Transforming growth factor-β (TGF- β) is abundant in bone matrix and has been shown to regulate the activity of osteoblasts and osteoclasts in vitro. All isoforms of TGF- β are expressed in bone and intricately play role in bone homeostasis by modulating estrogen level. Ovariectomised animal have shown down regulation of TGF- β in bone that could also be a probable target of AEDs therapy associated bone loss. One of the widely accepted hypotheses regarding the conventional drugs induced bone loss is hypovitaminosis D which is by virtue of their microsomal enzyme inducing effect. However, despite of the lack of enzyme inducing effect of certain newer antiepileptic drugs, reduced bone mineral density with these drugs have also been reported. Thus an understanding of bone biology, pathophysiology of AEDs induced bone loss at molecular level can aid in the better management of bone loss in patients on chronic AEDs therapy. This review focuses mainly on certain new molecular targets of AEDs induced bone loss.
Collapse
Affiliation(s)
- Md Jamir Anwar
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia.
| | - Sattam K Alenezi
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia
| | - Danish Mahmood
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia
| | - Faizul Azam
- Department of Pharmaceutical Chemistry & Pharmacognosy, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia
| | - Khalid Saad Alharbi
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakakah, Saudi Arabia
| |
Collapse
|
15
|
Matuszewska A, Nowak B, Nikodem A, Merwid-Ląd A, Wiatrak B, Tomkalski T, Jędrzejuk D, Szeląg E, Sozański T, Danielewski M, Jawień P, Ceremuga I, Szandruk-Bender M, Bolanowski M, Filipiak J, Szeląg A. Antiepileptic Stiripentol May Influence Bones. Int J Mol Sci 2021; 22:7162. [PMID: 34281215 PMCID: PMC8269345 DOI: 10.3390/ijms22137162] [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] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
Bone structure abnormalities are increasingly observed in patients chronically treated with antiepileptic drugs (AEDs). The majority of the available data concern older conventional AEDs, while the amount of information regarding newer AEDs, including stiripentol, is limited. The aim of the study was to assess the effect of stiripentol on bones. For 24 weeks, male Wistar rats, received 0.9% sodium chloride (control group) or stiripentol (200 mg/kg/day) (STP group). In the 16th week of the study, we detected lower serum PINP levels in the STP group compared to the control group. In the 24th week, a statistically significant lower 1,25-dihydroxyvitamin D3 level, higher inorganic phosphate level and higher neutrophil gelatinase-associated lipocalin (NGAL) levels in serum were found in the STP group compared to the control. Micro X-ray computed tomography of the tibias demonstrated lower bone volume fraction, lower trabecular thickness, higher trabecular pattern factor and a higher structure model index in the stiripentol group. Considering the results of this experiment on rats which suggests that long-term administration of stiripentol may impair the cancellous bone microarchitecture, further prospective human studies seem to be justified. However, monitoring plasma vitamin D, calcium, inorganic phosphate and kidney function in patients on long-term stiripentol therapy may be suggested.
Collapse
Affiliation(s)
- Agnieszka Matuszewska
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Beata Nowak
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Anna Nikodem
- Department of Mechanics, Materials and Biomedical Engineering, Wroclaw University of Science and Technology, ul. Ignacego Łukasiewicza 7/9, 50-371 Wrocław, Poland; (A.N.); (J.F.)
| | - Anna Merwid-Ląd
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Benita Wiatrak
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Tomasz Tomkalski
- Department of Endocrinology, Diabetology and Internal Medicine, Tadeusz Marciniak Lower Silesia Specialist Hospital—Centre for Medical Emergency, ul. Gen. Augusta Emila Fieldorfa 2, 54-049 Wrocław, Poland;
| | - Diana Jędrzejuk
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, wyb. Ludwika Pasteura 4, 50-367 Wrocław, Poland; (D.J.); (M.B.)
| | - Ewa Szeląg
- Department of Maxillofacial Orthopedics and Orthodontics Institute, Wroclaw University of Science and Technology, ul. Krakowska 26, 50-425 Wrocław, Poland;
| | - Tomasz Sozański
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Maciej Danielewski
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Paulina Jawień
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Ireneusz Ceremuga
- Department of Medical Biochemistry, Wroclaw Medical University, ul. Tytusa Chałubińskiego 10, 50-368 Wrocław, Poland;
| | - Marta Szandruk-Bender
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, wyb. Ludwika Pasteura 4, 50-367 Wrocław, Poland; (D.J.); (M.B.)
| | - Jarosław Filipiak
- Department of Mechanics, Materials and Biomedical Engineering, Wroclaw University of Science and Technology, ul. Ignacego Łukasiewicza 7/9, 50-371 Wrocław, Poland; (A.N.); (J.F.)
| | - Adam Szeląg
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| |
Collapse
|
16
|
Matuszewska A, Nowak B, Szeląg A, Merwid-Ląd A, Partyka A, Tomkalski T, Podhorska-Okołów M, Piotrowska A, Kwiatkowska J, Niżański W. Long-term stiripentol administration, an anticonvulsant drug, does not impair sperm parameters in rats. Andrologia 2021; 53:e14058. [PMID: 33792946 DOI: 10.1111/and.14058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/25/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
In this study, we investigated the influence of long-term administration of stiripentol on sex hormones and semen quality in young Wistar rats. Investigated animals received for 6 months either stiripentol or saline solution. After one month, stiripentol increased temporarily serum level of testosterone (p < 0.05) and FSH (p < 0.01). However, after 6 months levels of testosterone, FSH, LH, prolactin and SHBG were comparable in both groups. After 6 months, semen analysis did not reveal differences in sperm concentration, total sperm count and sperm motility between groups. However, stiripentol increased the rate of head defect (p < 0.001) and midpiece abnormalities (p < 0.05). Flow cytometry revealed higher percentage of live cells without lipid peroxidation (p < 0.00001) and higher percentage of live spermatozoa with intact acrosomes (p < 0.000001) in rats receiving stiripentol. There was no significant difference between groups in sperm mitochondrial activity and DNA fragmentation index. However, percentage of high DNA stainability cells was increased in stiripentol group (p < 0.001). The data showed that stiripentol does not cause obvious disturbances in young rat's semen. Detected changes in semen morphology and chromatin structure need further explanation, and their influence on rat's fertility should be evaluated.
Collapse
Affiliation(s)
| | - Beata Nowak
- Department of Pharmacology, Wroclaw Medical University, Wroclaw, Poland
| | - Adam Szeląg
- Department of Pharmacology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Merwid-Ląd
- Department of Pharmacology, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Partyka
- Department of Reproduction and Clinic of Farm Animals, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Tomasz Tomkalski
- Department of Endocrinology, Diabetology and Internal Medicine, Hospital in Lower Silesia Tadeusz Marciniak Center for Emergency Medicine, Wroclaw, Poland
| | | | - Aleksandra Piotrowska
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Wojciech Niżański
- Department of Reproduction and Clinic of Farm Animals, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| |
Collapse
|
17
|
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.
Collapse
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.)
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | - Zucai Xu
- *Correspondence: Changyin Yu, ; Zucai Xu,
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Osuntokun OS, Akinsomisoye SO, Olayiwola G, Adedokun KI, Oladokun OO. Carbamazepine adversely altered the pituitary-testicular axis with resultant reproductive dysfunctions than levetiracetam or carbamazepine-levetiracetam adjuvant treatment in male Wistar rat. Andrologia 2020; 52:e13871. [PMID: 33126292 DOI: 10.1111/and.13871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
This study investigated the on-toward reactions of individual or adjunctive treatment with carbamazepine (CBZ) and levetiracetam (LEV) on the pituitary-testicular axis in male rats. Twenty-four male Wistar rats were randomised into 4 groups (n = 6) and received daily intraperitoneal (i.p) treatment of normal saline (0.1 ml/day); CBZ (25 mg/kg i.p); LEV (50 mg/kg i.p); or combination of CBZ (12.5 mg/kg) and LEV (25 mg/kg) for 4 weeks. The serum concentration of luteinising hormone (LH), follicle-stimulating hormone (FSH), and testosterone was determined. Also, the seminal profile and histomorphological status of the testis were determined. Data were analysed using descriptive and inferential statistics. The control and test groups were compared using Student's t test, analysis of variance (ANOVA), and Student-Newman-Keuls post hoc analysis where appropriate, while the results presented as mean ± SEM in graphs or tables. The level of significance was taken at p < .05. The percentage motility, viability, and concentration of FSH decreased significantly in all the treatment groups, while the testis was presented with various forms of histomorphological aberrations. This study concludes that CBZ, and CBZ + LEV adjunctive treatments alter the pituitary-testicular axis with evidence of hormonal deregulation and alteration in the reproductive functions' indices, while LEV treatment remains the safest.
Collapse
Affiliation(s)
- Opeyemi Samson Osuntokun
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Stephen Olumide Akinsomisoye
- Department of Physiological Sciences, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Gbola Olayiwola
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy Obafemi, Awolowo University, Ile-Ife, Nigeria
| | - Kabiru Isola Adedokun
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Olayemi Olutobi Oladokun
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| |
Collapse
|
22
|
Osuntokun OS, Olayiwola G, Atere TG, Adekomi DA, Adedokun KI, Oladokun OO. Hypothalamic-pituitary-testicular axis derangement following chronic phenytoin-levetiracetam adjunctive treatment in male Wistar rats. Andrologia 2020; 52:e13788. [PMID: 33017495 DOI: 10.1111/and.13788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 02/02/2023] Open
Abstract
The effects of phenytoin (PHT), levetiracetam (LEV) or their adjunctive treatment on the hypothalamic-pituitary-testicular axis in male Wistar rats were determined. Twenty-eight male rats (150-180 g) were randomised into four groups (N = 7). Groups I to IV received intraperitoneal treatment of either normal saline (0.2 ml i.p) or PHT (50 mg/kg i.p) or LEV (50 mg/kg) or PHT (25 mg/kg) and LEV (25 mg/kg) combination for 28 days. The organ weight, concentrations of reproductive hormones and semen profile were determined, while the brain, epididymis and testis were preserved in 10% neutral-buffered formalin for the histomorphological study. Data were analysed using descriptive and inferential statistics. The results were presented as mean ± SEM in graphs or tables, while the level of significance was taken at p < .05. The semen profile was altered significantly in all the treatment groups. The gonadotrophic releasing hormone, luteinising hormone and testosterone concentration decreased significantly in the PHT- and PHT + LEV-treated groups compared with control. There were various disruptions in the hypothalamus, pituitary and testis of the PHT- and PHT + LEV adjunctive-treated rats. In conclusion, chronic PHT + LEV treatment may pose deleterious effects on the hypothalamic-pituitary-testicular axis than single treatment of either of the two drugs in male rats.
Collapse
Affiliation(s)
- Opeyemi S Osuntokun
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Gbola Olayiwola
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Tope G Atere
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Damilare A Adekomi
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Kabiru I Adedokun
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Olayemi O Oladokun
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| |
Collapse
|
23
|
Bafor EE, Ukpebor F, Elvis-Offiah U, Uchendu A, Omoruyi O, Omogiade GU. Justicia flava Leaves Exert Mild Estrogenic Activity in Mouse Models of Uterotrophic and Reproductive Cycle Investigations. J Med Food 2020; 23:395-408. [DOI: 10.1089/jmf.2019.0155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Enitome E. Bafor
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Edo State, Nigeria
| | - Faith Ukpebor
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Edo State, Nigeria
| | - Uloma Elvis-Offiah
- Department of Science and Laboratory Technology, Faculty of Science, University of Benin, Benin City, Edo State, Nigeria
| | - Adaeze Uchendu
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Edo State, Nigeria
| | - Osemelomen Omoruyi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Edo State, Nigeria
| | - Glory Uyi Omogiade
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Edo State, Nigeria
| |
Collapse
|
24
|
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.
Collapse
|
25
|
Rampogu S, Baek A, Bavi R, Son M, Cao GP, Kumar R, Park C, Zeb A, Rana RM, Park SJ, Lee KW. Identification of Novel Scaffolds with Dual Role as Antiepileptic and Anti-Breast Cancer. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2019; 16:1663-1674. [PMID: 30334765 DOI: 10.1109/tcbb.2018.2855138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aromatase inhibitors with an $\mathrm{IC}_{50}$ IC 50 value ranging from 1.4 to 49.7 µM are known to act as antiepileptic drugs besides being potential breast cancer inhibitors. The aim of the present study is to identify novel antiepileptic aromatase inhibitors with higher activity exploiting the ligand-based pharmacophore approach utilizing the experimentally known inhibitors. The resultant Hypo1 consists of four features and was further validated by using three different strategies. Hypo1 was allowed to screen different databases to identify lead molecules and were further subjected to Lipinski's Rule of Five and ADMET to establish their drug-like properties. Consequently, the obtained 68-screened molecules were subjected to molecular docking by GOLD v5.2.2. Furthermore, the compounds with the highest dock scores were assessed for molecular interactions. Later, the MD simulation was applied to evaluate the protein backbone stabilities and binding energies adapting GROMACS v5.0.6 and MM/PBSA which was followed by the density functional theory (DFT), to analyze their orbital energies, and further the energy gap between them. Eventually, the number of Hit molecules was culled to three projecting Hit1, Hit2, and Hit3 as the potential lead compounds based on their highest dock scores, hydrogen bond interaction, lowest energy gap, and the least binding energies and stable MD results.
Collapse
|
26
|
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
|
27
|
Ganjkhani M, Nourozi S, Bigonah R, Rostami A, Shokri S. Ameliorating impacts of ginseng on the apoptosis of spermatogenic cells and sperm quality in temporal lobe epilepsy rat model treated with valproate. Andrologia 2019; 51:e13348. [DOI: 10.1111/and.13348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
- Mahin Ganjkhani
- Department of Physiology and Pharmacology, School of Medicine Zanjan University of Medical Sciences Zanjan Iran
| | - Saeed Nourozi
- Department of Physiology and Pharmacology, School of Medicine Zanjan University of Medical Sciences Zanjan Iran
| | - Reza Bigonah
- Department of Physiology and Pharmacology, School of Medicine Zanjan University of Medical Sciences Zanjan Iran
| | - Ali Rostami
- Department of Physiology and Pharmacology, School of Medicine Zanjan University of Medical Sciences Zanjan Iran
| | - Saeed Shokri
- Department of Anatomical Sciences, School of Medicine Zanjan University of Medical Sciences Zanjan Iran
| |
Collapse
|
28
|
Flotynska J, Uruska A, Michalska A, Araszkiewicz A, Zozulinska-Ziolkiewicz D. Sexual Dysfunction Is a More Common Problem in Young Women with Type 1 Diabetes than in Healthy Women. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:643-651. [PMID: 31007158 DOI: 10.1080/0092623x.2019.1610121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of the study was to analyze the relationship between the presence of type 1 diabetes and sexual dysfunction among young women. The study group consisted of 230 women, including 70 healthy and 160 with diabetes mellitus type 1 (DM1). All the participants voluntarily filled anonymous questionnaire. The results regarding sexual function were obtained using a Female Sexual Function Index (FSFI) questionnaire. Statistical analysis was performed for sexually active people. In the study group, 180 women declared sexual activity: 62 healthy (88%) and 118 with DM1 (82.5%). Women with DM1 in comparison with healthy women were older, had higher BMI, weight, and had more pack-years of cigarette smoking. Women with DM1 had lower results in FSFI and more often achieved scores below the clinical cutoff point. In a multiple linear regression model, the presence of diabetes predicted lower FSFI results. DM1 is independently associated with the presence of impaired sexual function. Sexual dysfunctions are more common among young women with DM1 than in healthy controls. The relationship is significant despite of the age, duration of diabetes, body weight, and presence of angiopathy.
Collapse
Affiliation(s)
- Justyna Flotynska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
| | - Anna Michalska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
| | - Aleksandra Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
| | - Dorota Zozulinska-Ziolkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
| |
Collapse
|
29
|
Abbo C, Mwaka AD, Opar BT, Idro R. Qualitative evaluation of the outcomes of care and treatment for children and adolescents with nodding syndrome and other epilepsies in Uganda. Infect Dis Poverty 2019; 8:30. [PMID: 31036087 PMCID: PMC6489326 DOI: 10.1186/s40249-019-0540-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 04/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background In 2012, the Ugandan Government declared an epidemic of Nodding Syndrome (NS) in the Northern districts of Gulu, Kitgum, Lamwo and Pader. Treatment guidelines were developed and NS treatment centres were established to provide symptomatic control and rehabilitation. However, a wide gap remained between the pre-defined care standards and the quality of routine care provided to those affected. This study is to qualitatively assess adherence to accepted clinical care standards for NS; identify gaps in the care of affected children and offer Clinical Support Supervision (CSS) to Primary Health Care (PHC) staff at the treatment centres; and identify psychosocial challenges faced by affected children and their caregivers. Methods This case study was carried out in the districts of Gulu, Kitgum, Lamwo and Pader in Uganda from September to December in 2015. Employing the 5-stage approach of Clinical Audit, data were collected through direct observations and interviews with PHC providers working in public and private-not-for-profit health facilities, as well as with caregivers and political leaders. The qualitative data was analysed using Seidel model of data processing. Results Clinical Audit and CSS revealed poor adherence to treatment guidelines. Many affected children had sub-optimal NS management resulting in poor seizure control and complications including severe burns. Root causes of these outcomes were frequent antiepileptic drugs stock outs, migration of health workers from their work stations and psychosocial issues. There was hardly any specialized multidisciplinary team (MDT) to provide for the complex rehabilitation needs of the patients and a task shifting model with inadequate support supervision was employed, leading to loss of skills learnt. Reported psychosocial and psychosexual issues associated with NS included early pregnancies, public display of sexual behaviours and child abuse. Conclusions Despite involvement of relevant MDT members in the development of multidisciplinary NS guidelines, multidisciplinary care was not implemented in practice. There is urgent need to review the NS clinical guidelines. Quarterly CSS and consistent anticonvulsant medication are needed at health facilities in affected communities. Implementation of the existing policies and programs to deal with the psychosocial and psychosexual issues that affect children with NS and other chronic conditions is needed. Electronic supplementary material The online version of this article (10.1186/s40249-019-0540-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Catherine Abbo
- Department of Psychiatry, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Richard Idro
- Department of Paediatrics, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
30
|
Tutka P, Mróz K, Mróz T, Buszewicz G, Aebisher D, Bartusik-Aebisher D, Kołodziejczyk P, Łuszczki JJ. Effects of androsterone on the protective action of various antiepileptic drugs against maximal electroshock-induced seizures in mice. Psychoneuroendocrinology 2019; 101:27-34. [PMID: 30408720 DOI: 10.1016/j.psyneuen.2018.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/20/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
This study evaluated the effect of androsterone (AND), a metabolite of testosterone, on the ability of selected classical and novel antiepileptic drugs to prevent seizures caused by maximal electroshock (MES), which may serve as an experimental model of human generalized tonic-clonic seizures in mice. Single intraperitoneal (i.p.) administration of AND (80 mg kg-1) significantly raised the threshold for convulsions in the MES seizure threshold test. Lower doses of AND (5, 10, 20, and 40 mg kg-1) failed to change the threshold. AND at a subthreshold dose of 40 mg kg-1 significantly enhanced the protective activity of carbamazepine, gabapentin, and phenobarbital against MES-induced seizures decreasing their median effective doses (ED50) values ± SEM from 8.59 ± 0.76 to 6.05 ± 0.81 mg kg-1 (p = 0.0308) for carbamazepine, from 419.9 ± 120.6 to 111.5 ± 41.1 mg kg-1 (p = 0.0405) for gabapentin, and from 20.86 ± 1.64 to 10.0 ± 1.21 mg kg-1 (p = 0.0007) for phenobarbital. There were no significant changes in total brain concentrations of carbamazepine, gabapentin, and phenobarbital following AND administration. This suggests that the enhancing effects of AND on the protective activity of these antiepileptic drugs are not related to pharmacokinetic factors. A lower dose of AND (20 mg kg-1) had no effect on the protective activity of carbamazepine, gabapentin, and phenobarbital. AND administered at a dose of 40 mg kg-1 failed to change the anticonvulsant activity of lamotrigine, oxcarbazepine, phenytoin, topiramate, and valproate in the MES test. In the chimney test, AND given at a dose enhancing the protective activity of carbamazepine, gabapentin, and phenobarbital (which alone was without effect on motor performance of mice) did not affect impairment of motor coordination produced by the antiepileptics. Our findings recommend further preclinical and clinical research on AND in respect of its use as adjuvant therapy in the management of epilepsy in men with deficiency of androgens.
Collapse
Affiliation(s)
- Piotr Tutka
- Department of Experimental and Clinical Pharmacology, Faculty of Medicine, University of Rzeszów, Al. Kopisto 2a, PL, 35-959, Rzeszów, Poland; Laboratory for Innovative Research in Pharmacology, Centre for Innovative Research in Medical and Natural Sciences', University of Rzeszów, Warzywna 1A, PL, 35-310, Rzeszów, Poland.
| | - Katarzyna Mróz
- Department of Neurology, District Hospital, Cicha 14, PL, 21-100, Lubartów, Poland
| | - Tomasz Mróz
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Jaczewskiego 8b, PL, 20-090, Lublin, Poland
| | - Grzegorz Buszewicz
- Laboratory of Forensic Toxicology, Medical University of Lublin, Jaczewskiego 8b, PL, 20-090, Lublin, Poland
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Faculty of Medicine, University of Rzeszów, Al. Kopisto 2a, PL, 35-959, Rzeszów, Poland
| | - Dorota Bartusik-Aebisher
- Department of Experimental and Clinical Pharmacology, Faculty of Medicine, University of Rzeszów, Al. Kopisto 2a, PL, 35-959, Rzeszów, Poland
| | - Patrycjusz Kołodziejczyk
- Department of Experimental and Clinical Pharmacology, Faculty of Medicine, University of Rzeszów, Al. Kopisto 2a, PL, 35-959, Rzeszów, Poland
| | - Jarogniew J Łuszczki
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8b, PL, 20-090, Lublin, Poland
| |
Collapse
|
31
|
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.
Collapse
|
32
|
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.
Collapse
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.
| |
Collapse
|
33
|
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
|
34
|
Shawahna R. Which information on women's issues in epilepsy does a community pharmacist need to know? A Delphi consensus study. Epilepsy Behav 2017; 77:79-89. [PMID: 29127865 DOI: 10.1016/j.yebeh.2017.09.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to develop and achieve consensus on a core list of important knowledge items that community pharmacists should know on women's issues in epilepsy. METHODS This was a consensual study using a modified Delphi technique. Knowledge items were collected from the literature and from nine key contacts who were interviewed on their views on what information community pharmacists should have on women's issues in epilepsy. More knowledge items were suggested by five researchers with interest in women's issues who were contacted to rate and comment on the knowledge items collected. Two iterative Delphi rounds were conducted among a panel of pharmacists (n=30) to achieve consensus on the knowledge items to be included in the core list. Ten panelists ranked the knowledge items by their importance using the Analytical Hierarchy Process (AHP). RESULTS Consensus was achieved to include 68 knowledge under 13 categories in the final core list. Items ranked by their importance were related to the following: teratogenicity (10.3%), effect of pregnancy on epilepsy (7.4%), preconception counseling (10.3%), bone health (5.9%), catamenial epilepsy (7.4%), menopause and hormonal replacement therapy (2.9%), contraception (14.7%), menstrual disorders and infertility (8.8%), eclampsia (2.9%), breastfeeding (4.4%), folic acid and vitamin K (5.9%), counseling on general issues (14.7%), and sexuality (4.4%). CONCLUSION Using consensual knowledge lists might promote congruence in educating and/or training community pharmacists on women's issues in epilepsy. Future studies are needed to investigate if such lists can improve health services provided to women with epilepsy (WWE).
Collapse
Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
| |
Collapse
|
35
|
Semet M, Paci M, Saïas-Magnan J, Metzler-Guillemain C, Boissier R, Lejeune H, Perrin J. The impact of drugs on male fertility: a review. Andrology 2017. [PMID: 28622464 DOI: 10.1111/andr.12366] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Beside cytotoxic drugs, other drugs can impact men's fertility through various mechanisms. Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may directly and indirectly induce sexual dysfunction and spermatogenesis impairment and alteration of epididymal maturation. This systematic literature review summarizes existing data about the negative impact and associations of pharmacological treatments on male fertility (excluding cytotoxic drugs), with a view to making these data more readily available for medical staff. In most cases, these effects on spermatogenesis/sperm maturation/sexual function are reversible after the discontinuation of the drug. When a reprotoxic treatment cannot be stopped and/or when the impact on semen parameters/sperm DNA is potentially irreversible (Sulfasalazine Azathioprine, Mycophenolate mofetil and Methotrexate), the cryopreservation of spermatozoa before treatment must be proposed. Deleterious impacts on fertility of drugs with very good or good level of evidence (Testosterone, Sulfasalazine, Anabolic steroids, Cyproterone acetate, Opioids, Tramadol, GhRH analogues and Sartan) are developed.
Collapse
Affiliation(s)
- M Semet
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France
| | - M Paci
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France.,Aix Marseille Univ, INSERM, GMGF UMR_S 910, Marseille, France
| | - J Saïas-Magnan
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France
| | - C Metzler-Guillemain
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France.,Aix Marseille Univ, INSERM, GMGF UMR_S 910, Marseille, France
| | - R Boissier
- Aix-Marseille University, Marseille, France.,Department of Urology and Renal Transplantation, APHM, Conception University Hospital, Marseille, France
| | - H Lejeune
- Service de Médecine de la Reproduction, Hôpital Femme Mère, Enfant, CHU de Lyon, Bron, France
| | - J Perrin
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France.,Aix Marseille Univ, Univ Avignon, CNRS, IRD, IMBE, Marseille, France
| |
Collapse
|
36
|
Purslane protects against the reproductive toxicity of carbamazepine treatment in pilocarpine-induced epilepsy model. Asian Pac J Trop Biomed 2017. [DOI: 10.1016/j.apjtb.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
37
|
Mameniškienė R, Guk J, Jatužis D. Family and sexual life in people with epilepsy. Epilepsy Behav 2017; 66:39-44. [PMID: 28025177 DOI: 10.1016/j.yebeh.2016.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/18/2022]
Abstract
Having epilepsy is much more than having seizures. Epilepsy can have a severe negative effect on quality of life, affecting social relationships, academic achievement, housing, employment, and the ability to live and function independently. We undertook a cross-sectional study in a tertiary epilepsy center in Lithuania, aiming to assess the influence of epilepsy and aspects relating to epilepsy (employment, stigma, anxiety) on patients and their families, and to estimate their quality of family life and sexual functioning. We asked patients to complete a questionnaire about their socio-demographic situation, their seizure types and antiepileptic medications, and their quality of family and sexual life. Our results confirmed that epilepsy seriously influences family life. One third of our patients are lonely and half are childless. Epilepsy leads to difficulty in finding a job, especially for men, and unemployment affects their status in the family. People with epilepsy are uncomfortable interacting with those of the opposite sex and tend to conceal their medical condition from their partner. One third have sexual dysfunction, yet only a quarter of them seek professional help. There is a clear need to improve self-confidence and to reduce social stigma in people with epilepsy, and to encourage them to discuss their problems with specialists.
Collapse
Affiliation(s)
- Rūta Mameniškienė
- Vilnius University, Department of Neurology and Neurosurgery, Center for Neurology, Vilnius, Lithuania.
| | - Jevgenija Guk
- Department of Neurology, Vilnius University Hospital "Santariškių klinikos", Vilnius, Lithuania
| | - Dalius Jatužis
- Vilnius University, Department of Neurology and Neurosurgery, Center for Neurology, Vilnius, Lithuania
| |
Collapse
|
38
|
Li J, Kim JS, Abejuela VA, Lamano JB, Klein NJ, Christian CA. Disrupted female estrous cyclicity in the intrahippocampal kainic acid mouse model of temporal lobe epilepsy. Epilepsia Open 2016; 2:39-47. [PMID: 29750212 PMCID: PMC5939433 DOI: 10.1002/epi4.12026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/08/2022] Open
Abstract
Objective Reproductive dysfunction is a comorbidity that commonly occurs with temporal lobe epilepsy (TLE). Characterization of this comorbidity in various models of TLE in mice will greatly facilitate mechanistic investigations of the relationship between reproductive disorders and seizures initiated in the hippocampus. Here we investigate the impact on female reproductive estrous cyclicity in the intrahippocampal kainic acid mouse model of TLE and demonstrate the utility of using this model for future mechanistic studies. Methods Kainic acid (KA) or saline vehicle was stereotaxically injected in the right dorsal hippocampus of adult female C57BL/6J mice. Development of epilepsy was assessed by video monitoring for behavioral seizures. Reproductive function was assessed by daily estrous cycle monitoring and ovarian morphology. Estrous cycles were monitored for up to 2 months after injection. Ovarian morphology was examined by histological staining and assessment of follicular and luteal development. Results We observed spontaneous behavioral seizures in 82% of kainic-acid-treated mice. Irregular estrous cycles developed within 2 months after kainic acid injection. Sixty-seven percent of KA-treated mice showed disrupted estrous cycles, typically characterized by increased estrous cycle length, increased time spent in diestrus (nonfertile stage), and decreased time spent in estrus by 42 days post-KA injection. The estrous cycle disruption, however, was not accompanied by major changes in ovarian morphology or follicular development. KA-treated mice also displayed increased weight gain compared to control mice. Significance These data indicate that comorbid female irregular estrous cyclicity arises in the intrahippocampal kainic acid mouse model of TLE. This is the first demonstration of disrupted reproductive endocrine function in a mouse model of TLE initially produced by an insult specifically targeted to the hippocampus. This model should thus be useful for basic studies investigating the neural mechanisms driving comorbid reproductive dysfunction in epilepsy in women.
Collapse
Affiliation(s)
- Jiang Li
- Neuroscience Program University of Illinois at Urbana-Champaign Urbana Illinois U.S.A
| | - Jae Seong Kim
- Department of Molecular and Integrative Physiology University of Illinois at Urbana-Champaign Urbana Illinois U.S.A
| | - Vincent A Abejuela
- Department of Molecular and Integrative Physiology University of Illinois at Urbana-Champaign Urbana Illinois U.S.A
| | - Jason B Lamano
- Department of Molecular and Integrative Physiology University of Illinois at Urbana-Champaign Urbana Illinois U.S.A
| | - Natalie J Klein
- Department of Molecular and Integrative Physiology University of Illinois at Urbana-Champaign Urbana Illinois U.S.A
| | - Catherine A Christian
- Neuroscience Program University of Illinois at Urbana-Champaign Urbana Illinois U.S.A.,Department of Molecular and Integrative Physiology University of Illinois at Urbana-Champaign Urbana Illinois U.S.A
| |
Collapse
|
39
|
Karlov VA, Guekht AB, Guzeva VI, Lipatova LV, Bazilevich SN, Mkrtchyan VR, Vlasov PN, Zhidkova IA, Mukhin KY, Petrukhin AS, Lebedeva AV. [Algorithms of mono- and polytherapy in clinical epileptology]. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [PMID: 28635941 DOI: 10.17116/jnevro201611671120-129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The large number of antiepileptic drugs (AEDs) at the physician's disposal provides not only a broad therapeutic potential in the treatment of epilepsy (EP), but creates difficulties in the adequate choice of AED. The sufficient experience in the management of patients with epilepsy has been gained so far in the world, based on which the International League Against Epilepsy (ILAE), updated classification, adopted the basic definition of efficiency, remission, resistance, evidence of research on the effectiveness of AED therapy, and introduced the concept of "resolved" epilepsy. In this article, a group of Russian experts suggest recommendations on the main steps in the choice of therapy in epilepsy. Possible drug interactions between different AEDs and other drugs as well as main characteristics of mono- and polytherapy of epilepsy are described. Some features of the use of AEDs in the elderly, characteristics of the "female" epilepsy related to the reproductive function and basic requirements for the therapy of epilepsy in children are presented.
Collapse
Affiliation(s)
- V A Karlov
- Evdokimov Moscow State Medical and Dentistry University, Moscow, Russia
| | - A B Guekht
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V I Guzeva
- Saint-Petersburg State Medical Academy, St. Petersburg, Russia
| | - L V Lipatova
- Bekhterev Saint-Petersburg Research Psychoneurological Institute, St. Petersburg, Russia
| | | | - V R Mkrtchyan
- Soloviev Scientific-Practical Psycho-Neurological Сenter, Moscow, Russia
| | - P N Vlasov
- Evdokimov Moscow State Medical and Dentistry University, Moscow, Russia
| | - I A Zhidkova
- Evdokimov Moscow State Medical and Dentistry University, Moscow, Russia
| | - K Yu Mukhin
- Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow, Russia
| | - A S Petrukhin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Lebedeva
- Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
40
|
Yang Y, Wang X. Sexual dysfunction related to antiepileptic drugs in patients with epilepsy. Expert Opin Drug Saf 2015; 15:31-42. [PMID: 26559937 DOI: 10.1517/14740338.2016.1112376] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Epilepsy is a common disease that is mostly treated with antiepileptic drugs (AEDs). However, the sexual dysfunction (SD) side effects related to the use of AEDs have not received sufficient attention. AREAS COVERED The purpose of this review is to examine the current evidence on SD-related side effects of AEDs. The incidence, clinical features and major types of SD are summarized. Furthermore, various AEDs that may cause SDs are addressed in detail. Finally, we briefly summarize the treatments for SD related to AEDs. EXPERT OPINION SD related to AEDs is common. Symptoms include erectile dysfunction (ED), hyposexuality, hypersexuality and ejaculatory dysfunction. Traditional AEDs such as valproate and enzyme-inducing AEDs (EIAEDs) may produce high incidences of decreased libido. Recently, sexual function changes related to new AEDs have been reported. Topiramate, pregabalin and gabapentin may cause SD, whereas oxcarbazepine, lamotrigine and levetiracetam may improve sexual function. Although the treatment for SD related to AEDs remains unclear, switching to another AED may be an option. Further studies are necessary to better understand and treat SD related to AEDs.
Collapse
Affiliation(s)
- Yong Yang
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology , Chongqing 400016 , China
| | - Xuefeng Wang
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology , Chongqing 400016 , China
| |
Collapse
|
41
|
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]
|
42
|
Interactions between antiepileptic drugs and hormones. Seizure 2015; 28:12-7. [PMID: 25797888 DOI: 10.1016/j.seizure.2015.02.022] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 11/21/2022] Open
Abstract
Antiepileptic drugs (AEDs) are known to have endocrine side effects in both men and women. These can affect fertility, sexuality, thyroid function, and bone health, all functions of major importance for well-being and quality of life. The liver enzyme inducing antiepileptic drugs (EIAEDs), like phenobarbital, phenytoin, and carbamazepine, and also valproate (VPA), a non-EIAED, are most likely to cause such side effects. AED treatment can alter the levels of different sex hormones. EIAEDs increase sex hormone binding globulin (SHBG) concentrations in both men and women. Over time, this elevation can lead to lower levels of bioactive testosterone and estradiol, which may cause menstrual disturbances, sexual problems, and eventually reduced fertility. VPA can cause weight gain in both men and women. In women, VPA can also lead to androgenization with increased serum testosterone concentrations, menstrual disturbances, and polycystic ovaries. Lamotrigine has not been shown to result in endocrine side effects. The newer AEDs have not yet been thoroughly studied, but case reports indicate that some of these drugs could also be suspected to cause such effects if endocrine changes commence after treatment initiation. It is important to be aware of possible endocrine side effects of AEDs as they can have a major impact on quality of life, and are, at least partly, reversible after AED discontinuation.
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
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]
|
45
|
Shokri S, Kazemi M, Firouzjaei MA, Hemadi M, Moayeri A, Ganjkhani M, Nejatbakhsh R. Melatonin protects testes against lithium-pilocarpine-induced temporal lobe epilepsy in rats: a time course study. Andrologia 2014; 47:343-53. [DOI: 10.1111/and.12269] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 02/04/2023] Open
Affiliation(s)
- S. Shokri
- Department of Anatomy; School of Medicine; Zanjan University of Medical Sciences (ZUMS); Zanjan Iran
| | - M. Kazemi
- Department of Physiology; School of Medicine; ZUMS; Zanjan Iran
| | - M. A. Firouzjaei
- Department of Physiology; School of Medicine; Babol University of Medical Sciences (MUBabol); Babol Iran
| | - M. Hemadi
- Fertility, Infertility and Perinatology Research Center; Imam khomeini Hospital; Faculty of Medicine; Ahvaz Jundishapur University of Medical Sciences (AJUMS); Ahvaz Iran
| | - A. Moayeri
- Department of Anatomy; School of Medicine; Ilam University of Medical Sciences (MedIlam); Ilam Iran
| | - M. Ganjkhani
- Department of Physiology; School of Medicine; ZUMS; Zanjan Iran
| | - R. Nejatbakhsh
- Department of Anatomy; School of Medicine; Zanjan University of Medical Sciences (ZUMS); Zanjan Iran
| |
Collapse
|
46
|
Calabrò RS, Marino S, Bramanti P. Sexual and reproductive dysfunction associated with antiepileptic drug use in men with epilepsy. Expert Rev Neurother 2014; 11:887-95. [DOI: 10.1586/ern.11.58] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
47
|
Thomas SV, Sarma PS, Nirmala C, Mathai A, Thomas SE, Thomas AC. Women with epilepsy and infertility have different reproductive hormone profile than others. Ann Indian Acad Neurol 2013; 16:544-8. [PMID: 24339576 PMCID: PMC3841597 DOI: 10.4103/0972-2327.120460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 03/27/2013] [Accepted: 06/16/2013] [Indexed: 01/10/2023] Open
Abstract
Purpose: One-third of women with epilepsy (WWE) may experience infertility (failure to conceive after 12 months of regular unprotected intercourse). We aimed to compare the hormone profile of WWE and infertility (WWE-I) with that of WWE who had conceived earlier (WWE-F). Materials and Methods: In the Kerala Registry of Epilepsy and Pregnancy, we compared the clinical and hormone profile of 50 WWE-I and 40 age-matched WWE-F. Subjects were examined and blood samples were drawn in follicular phase (1-14 days) for 21 WWE-I and 18 WWE-F, in luteal phase (15-30 days) for 23 WWE-I and 15 WWE-F and beyond 30 days for 6 WWE-I and WWE-F who had irregular cycles. Results: The two groups were comparable regarding physical, epilepsy syndrome, duration of epilepsy, body mass index, and serum cholesterol levels. Menstrual periods were irregular for 6 WWE-I and 5 WWE-F. The WWE-I group (compared to the WWE-F group) had significantly (P < 0.01) higher levels of dehydroepiandrostenedione (2.0 ± 1.7 ug/mL vs. 1.0 ± 0.7 ug/mL) and luteinizing hormone-LH (26.4 ± 37.3 mIU/mL vs. 9.9 ± 14.5 mIU/mL) and lower levels of progesterone (5.2 ± 9.2 ng/mL vs. 10.4 ± 13.4 ng/mL). There was no significant difference in the levels of FT3, FT4, thyroid stimulating hormone, prolactin, follicle-stimulating hormone (FSH), progesterone, testosterone, or androstenedione levels. The WWE-I had 8.5 times higher risk (95% confidence interval 1.2-59.9) of abnormal LH/FSH ratio. WWE who were on antiepileptic drugs (AEDs) (compared to WWE who were not on AEDs) had higher risk of elevated LH/FSH ratio. Conclusion: The hormone profile of WWE-I is significantly different from that of WWE-F. These variations need to be interpreted with caution as a causal relationship to epilepsy or use of antiepileptic drugs need to be established through further studies.
Collapse
Affiliation(s)
- Sanjeev V Thomas
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | | | | |
Collapse
|
48
|
Badawy RAB, Vogrin SJ, Lai A, Cook MJ. Are patterns of cortical hyperexcitability altered in catamenial epilepsy? Ann Neurol 2013; 74:743-57. [PMID: 23686575 DOI: 10.1002/ana.23923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/13/2013] [Accepted: 04/26/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We used transcranial magnetic stimulation to determine menstrual cycle-related changes in cortical excitability in women with and without catamenial epilepsy and investigated whether these changes differed between ovulatory and anovulatory cohorts. METHODS Healthy nonepilepsy women and women with generalized and focal epilepsy were investigated during ovulatory (n=11, 46, and 43, respectively) and anovulatory (n=9, 42, and 41) cycles. Patients were divided based on seizure pattern into catamenial (C1=perimenstrual, C2=periovulatory, C3=luteal seizure exacerbation), noncatamenial, and seizure free. Cortical excitability was assessed using motor threshold (MT) and paired pulse stimulation at short (2-15 milliseconds) and long (100-300 milliseconds) interstimulus intervals twice, at the (1) late follicular and (2) mid luteal phases of the menstrual cycle. RESULTS In controls, cortical excitability was greatest in the follicular study, where intracortical facilitation was increased (p<0.05). The opposite was seen in women with epilepsy, where intracortical facilitation was greatest and intracortical inhibition was least in the luteal studies (p<0.05). There were no differences between the ovulatory and anovulatory groups in any of the cohorts. No changes were observed in MT. INTERPRETATION Nonhormonal factors are involved in the cyclicity of cortical excitability across the menstrual cycle. Normal menstrual cycle variations in cortical excitability are altered in a similar pattern in ovulatory and anovulatory women with epilepsy regardless of seizure patterns. The underlying neural changes associated with epilepsy may alter responses to sex hormones. This may be an important underlying mechanism for catamenial seizure clustering.
Collapse
Affiliation(s)
- Radwa A B Badawy
- Department of Clinical Neurosciences, St Vincent's Hospital, Fitzroy, Australia; Department of Medicine, University of Melbourne, Parkville, Australia; Electrical and Electronic Engineering, University of Melbourne, Parkville, Australia
| | | | | | | |
Collapse
|
49
|
Najafi M, Sadeghi MM, Mehvari J, Zare M, Akbari M. Progesterone therapy in women with intractable catamenial epilepsy. Adv Biomed Res 2013; 2:8. [PMID: 23930253 PMCID: PMC3732888 DOI: 10.4103/2277-9175.107974] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 07/08/2012] [Indexed: 01/11/2023] Open
Abstract
Background: Catamenial epilepsy is a kind of epilepsy, known in this name, when the periodicity of the exacerbation of the seizure is in association with menstural cycle. The present study examined the progesterone effectiveness as a complementary treatment in women with intractable catamenial epilepsy. Materials and Methods: The present study was conducted as a double-blind randomized controlled trial on 38 women with intractable catamenial epilepsy. Patients were assessed in two groups: The case group received in addition to AEDs, two (Mejestrol) 40 mg progesterone tablets in the second half of the cycle from 15th to 25th day. And the control group received in addition to AEDs, two placebo tablets daily. Age, BMI, epilepsy duration, types of the drugs used, progesterone level, and the number of the seizures in 3 months before and after the study were compared. Results: Based on the results of which there was no statistically significant difference in regard to age, BMI, epilepsy duration, types of the drugs used, progesterone level between the case and the control groups (P-value > 0.05). The number of the seizures after treatment has significantly decreased compared to before-treatment state. The degree of decreasing in the case group receiving the progesterone was higher than in the control group receiving the placebo. The difference, thus, is significant, based on statistical tests (P-value = 0.024). Conclusion: Based on the findings of this study using progesterone in women with intractable catamenial epilepsy has a significant effect on the degree of decreasing in the number of the seizures.
Collapse
Affiliation(s)
- Mohammadreza Najafi
- Department of Neurology, Isfahan Neuroscience Research Center, Isfahan, Iran
| | | | | | | | | |
Collapse
|
50
|
Metin SZ, Ozmen M, Ozkara C, Ozmen E. Hypersexuality in a patient with epilepsy during treatment of levetiracetam. Seizure 2012. [PMID: 23200413 DOI: 10.1016/j.seizure.2012.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|