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Zhang S, Wang T, Feng Y, Li F, Qu A, Guan X, Wang H, Xu D. Pregnenolone 16α-carbonitrile negatively regulates hippocampal cytochrome P450 enzymes and ameliorates phenytoin-induced hippocampal neurotoxicity. J Pharm Anal 2023; 13:1510-1525. [PMID: 38223454 PMCID: PMC10785155 DOI: 10.1016/j.jpha.2023.07.013] [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: 12/14/2022] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 01/16/2024] Open
Abstract
The central nervous system is susceptible to the modulation of various neurophysiological processes by the cytochrome P450 enzyme (CYP), which plays a crucial role in the metabolism of neurosteroids. The antiepileptic drug phenytoin (PHT) has been observed to induce neuronal side effects in patients, which could be attributed to its induction of CYP expression and testosterone (TES) metabolism in the hippocampus. While pregnane X receptor (PXR) is widely known for its regulatory function of CYPs in the liver, we have discovered that the treatment of mice with pregnenolone 16α-carbonitrile (PCN), a PXR agonist, has differential effects on CYP expression in the liver and hippocampus. Specifically, the PCN treatment resulted in the induction of cytochrome P450, family 3, subfamily a, polypeptide 11 (CYP3A11), and CYP2B10 expression in the liver, while suppressing their expression in the hippocampus. Functionally, the PCN treatment protected mice from PHT-induced hippocampal nerve injury, which was accompanied by the inhibition of TES metabolism in the hippocampus. Mechanistically, we found that the inhibition of hippocampal CYP expression and attenuation of PHT-induced neurotoxicity by PCN were glucocorticoid receptor dependent, rather than PXR independent, as demonstrated by genetic and pharmacological models. In conclusion, our study provides evidence that PCN can negatively regulate hippocampal CYP expression and attenuate PHT-induced hippocampal neurotoxicity independently of PXR. Our findings suggest that glucocorticoids may be a potential therapeutic strategy for managing the neuronal side effects of PHT.
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Affiliation(s)
- Shuai Zhang
- Department of Obstetric, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University, Wuhan, 430071, China
| | - Tingting Wang
- Department of Obstetric, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University, Wuhan, 430071, China
| | - Ye Feng
- Department of Endocrinology and Metabolic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Fei Li
- Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Aijuan Qu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Ministry of Education, Beijing, 100069, China
| | - Xiuchen Guan
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, 100069, China
| | - Hui Wang
- Department of Pharmacology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University, Wuhan, 430071, China
| | - Dan Xu
- Department of Obstetric, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan University, Wuhan, 430071, China
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Testicular androgens determining the incidence of spike-wave discharges in taiep rats: A model of H-ABC leukodystrophy. Neurosci Lett 2022; 782:136684. [PMID: 35595190 DOI: 10.1016/j.neulet.2022.136684] [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: 01/23/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022]
Abstract
Absence seizures are characterized as a generalized type of epilepsy that occurs during childhood. Importantly, absence seizures in children often discontinue after puberty. There is limited availability of animal models in which electroencephalography (EEG) can be performed in the long term; however, two absence seizure models, GAERS and WAG/Rij albino rats, are available. The taiep rat is a myelin mutant rat with tubulinopathy due to a tubulin β 4A gene mutation and characteristic spike-wave discharges (SWDs) that mimic absence seizure epilepsy in humans and the above rat models. This study aimed to analyze spike-wave discharges after an orchiectomy was performed on postnatal day (PND) 2 or PND 90 in adult rats; and SWDs was recorded in both groups on PND 104. The results suggest that androgens play a critical role in susceptibility to SWDs. In fact, orchiectomy during the neonatal period significantly reduced the frequency of spike-wave discharges. However, if an orchiectomy was performed in adulthood, then SWDs were significantly increased. The mean duration of spike-wave discharges did not differ among the groups tested. Acute administration of testosterone (1 mg/kg) did not change the frequency or duration of spike-wave discharges in the control group or both orchiectomized groups. Overall, this study is the first to show a dichotomic influence of testicular androgens on spike-wave discharges. These findings will have implications in children with this type of generalized epilepsy and may explain the disappearance of absence epilepsy in two-thirds of patients after puberty.
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Han SH, Lee H, Shin JY, Moon HJ, Lee SY. Real-world prescribing trends of valproate in women with epilepsy in Korea. Epilepsy Behav 2021; 115:107700. [PMID: 33421853 DOI: 10.1016/j.yebeh.2020.107700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
Avoiding valproate is recommended in women of childbearing age due to possible teratogenicity and infertility. We aimed to examine the recent trend of valproate prescriptions in Korea to review the adequacy of anticonvulsant prescriptions in women with epilepsy (WWE). Oral valproate utilization was assessed using nationwide and unselected data from the Korean National Health Insurance Service from 2009 to 2017. The temporal trends of the proportions of valproate prescriptions were analyzed using the Poisson regression model and expressed as average annual percentage change (AAPC). Among the WWE of childbearing age, valproate was prescribed in 37.0% overall and 29.4% as initial prescription in 2017. The proportion of valproate utilization showed a decreasing trend in overall prescription (AAPC = -1.10%) and initial prescription (AAPC = -2.63%). However, the proportion was static over time in the initial monotherapy group (AAPC = -0. 53%), while it was significantly decreasing in the initial polytherapy group (AAPC = -8.25%). A noticeable proportion of WWE was still being prescribed valproate in Korea. In particular, the use of valproate for initial monotherapy has not decreased over the past nine years. This result calls not only for reinforcement of education regarding anticonvulsant selection but also for monitoring the actual prescription.
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Affiliation(s)
- Su-Hyun Han
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea; Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Hye-Jin Moon
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
| | - Seo-Young Lee
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
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Kelicen-Ugur P, Cincioğlu-Palabıyık M, Çelik H, Karahan H. Interactions of Aromatase and Seladin-1: A Neurosteroidogenic and Gender Perspective. Transl Neurosci 2019; 10:264-279. [PMID: 31737354 PMCID: PMC6843488 DOI: 10.1515/tnsci-2019-0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/03/2019] [Indexed: 12/16/2022] Open
Abstract
Aromatase and seladin-1 are enzymes that have major roles in estrogen synthesis and are important in both brain physiology and pathology. Aromatase is the key enzyme that catalyzes estrogen biosynthesis from androgen precursors and regulates the brain’s neurosteroidogenic activity. Seladin-1 is the enzyme that catalyzes the last step in the biosynthesis of cholesterol, the precursor of all hormones, from desmosterol. Studies indicated that seladin-1 is a downstream mediator of the neuroprotective activity of estrogen. Recently, we also showed that there is an interaction between aromatase and seladin-1 in the brain. Therefore, the expression of local brain aromatase and seladin-1 is important, as they produce neuroactive steroids in the brain for the protection of neuronal damage. Increasing steroid biosynthesis specifically in the central nervous system (CNS) without affecting peripheral hormone levels may be possible by manipulating brain-specific promoters of steroidogenic enzymes. This review emphasizes that local estrogen, rather than plasma estrogen, may be responsible for estrogens’ protective effects in the brain. Therefore, the roles of aromatase and seladin-1 and their interactions in neurodegenerative events such as Alzheimer’s disease (AD), ischemia/reperfusion injury (stroke), and epilepsy are also discussed in this review.
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Affiliation(s)
- Pelin Kelicen-Ugur
- Hacettepe University, Faculty of Pharmacy, Department of Pharmacology, Sıhhiye Ankara Turkey
| | - Mehtap Cincioğlu-Palabıyık
- Turkish Medicines and Medical Devices Agency (TITCK), Department of Regulatory Affairs, Division of Pharmacological Assessment, Ankara, Turkey
| | - Hande Çelik
- Hacettepe University, Faculty of Pharmacy, Department of Pharmacology, Sıhhiye Ankara Turkey
| | - Hande Karahan
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
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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.
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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
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Hamed SA. The effect of epilepsy and antiepileptic drugs on sexual, reproductive and gonadal health of adults with epilepsy. Expert Rev Clin Pharmacol 2016; 9:807-19. [PMID: 26934627 DOI: 10.1586/17512433.2016.1160777] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Sherifa A. Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
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Medication Exposures and Subsequent Development of Ewing Sarcoma: A Review of FDA Adverse Event Reports. Sarcoma 2015; 2015:948159. [PMID: 26064078 PMCID: PMC4439508 DOI: 10.1155/2015/948159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/06/2015] [Accepted: 04/26/2015] [Indexed: 12/20/2022] Open
Abstract
Background. Ewing sarcoma family of tumors (ESFT) are rare but deadly cancers of unknown etiology. Few risk factors have been identified. This study was undertaken to ascertain any possible association between exposure to therapeutic drugs and ESFT. Methods. This is a retrospective, descriptive study. A query of the FDA Adverse Event Reporting System (FAERS) was conducted for all reports of ESFT, January 1, 1998, through December 31, 2013. Report narratives were individually reviewed for patient characteristics, underlying conditions and drug exposures. Results. Over 16 years, 134 ESFT reports were identified, including 25 cases of ESFT following therapeutic drugs and biologics including immunosuppressive agents and hormones. Many cases were confounded by concomitant medications and other therapies. Conclusions. This study provides a closer look at medication use and underlying disorders in patients who later developed ESFT. While this study was not designed to demonstrate any clear causative association between ESFT and prior use of a single product or drug class, many drugs were used to treat immune-related disease and growth or hormonal disturbances. Further studies may be warranted to better understand possible immune or neuroendocrine abnormalities or exposure to specific classes of drugs that may predispose to the later development of ESFT.
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Reis RM, de Angelo AG, Sakamoto AC, Ferriani RA, Lara LAS. Altered Sexual and Reproductive Functions in Epileptic Men Taking Carbamazepine. J Sex Med 2013; 10:493-9. [DOI: 10.1111/j.1743-6109.2012.02951.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Oliva SU, Scarano WR, Okada FK, Miraglia SM. Harmful effects of carbamazepine on the postnatal development of the rat ventral prostate. Reprod Biol Endocrinol 2012; 10:22. [PMID: 22443633 PMCID: PMC3344685 DOI: 10.1186/1477-7827-10-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/25/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Carbamazepine (CBZ) is a first-line antiepileptic drug (AED), although it is also used for the treatments of psychiatric disorders and neuropathic pain. The CBZ utilization has been associated with male reproductive damage, including hormonal alterations, sexual dysfunction and reduction of sperm quality. The wide and long-term use of the CBZ is a common schedule in children and adolescents and alters the testosterone level in adult rats and humans. The objective of this work was to evaluate the CBZ side effects on the ventral prostate of rats from pre-puberty to sexual maturation, since the prostate is an androgen-dependent organ. METHODS Twenty three day-old male albino Wistar rats received CBZ diluted in propylene glycol (20 mg/Kg/i.p via). The treatment lasted 20, 40 and 70 days, according to the different stages of the rat sexual maturation. At the end of each treatment period, ventral prostates were removed and histologically processed. The prostate sections were submitted to the histopathological, morphological and stereological analyses using image analysis system. RESULTS Reductions of the glandular epithelium, glandular lumen and fibromuscular stroma volume of the ventral prostate were observed in adult rats treated with CBZ since the weaning. Triggering and degranulation of mast cells were observed in the fibromuscular stroma of prepubertal and pubertal CBZ treated rats. CONCLUSIONS The results suggest a direct effect of the CBZ on rat ventral prostate, evidenced by increase of mast cell and macrophage populations during pre-puberty and puberty causing a ventral prostate accentuated damage in the adult phase.
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Affiliation(s)
- Samara U Oliva
- Department of Morphology and Genetics, Developmental Biology Laboratory, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Wellerson R Scarano
- Department of Morphology, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Fatima K Okada
- Department of Morphology and Genetics, Developmental Biology Laboratory, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandra M Miraglia
- Department of Morphology and Genetics, Developmental Biology Laboratory, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Topiramate related reversible erectile dysfunction in temporal lobe epilepsy. Neurol Sci 2011; 33:331-3. [DOI: 10.1007/s10072-011-0683-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/26/2011] [Indexed: 11/30/2022]
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Verrotti A, Loiacono G, Laus M, Coppola G, Chiarelli F, Tiboni GM. Hormonal and reproductive disturbances in epileptic male patients: Emerging issues. Reprod Toxicol 2011; 31:519-27. [DOI: 10.1016/j.reprotox.2011.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 01/12/2011] [Accepted: 02/14/2011] [Indexed: 01/23/2023]
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Meyer RP, Gehlhaus M. A role for CYP in the drug–hormone crosstalk of the brain. Expert Opin Drug Metab Toxicol 2010; 6:675-87. [DOI: 10.1517/17425251003680791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Verrotti A, D'Egidio C, Coppola G, Parisi P, Chiarelli F. Epilepsy, sex hormones and antiepileptic drugs in female patients. Expert Rev Neurother 2010; 9:1803-14. [PMID: 19951139 DOI: 10.1586/ern.09.112] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Women with epilepsy have a higher incidence of reproductive endocrine disorders than the general female population. These alterations include polycystic ovary syndrome, hyperandrogenemia, infertility, hypothalamic amenorrhea and hyperprolactinemia. Reproductive dysfunction is attributed both to epilepsy itself and to antiepileptic drugs (AEDs). Focal epileptic discharges from the temporal lobe may have a direct influence on the function of the hypothalamic-pituitary axis, thus altering the release of sex steroid hormones, including the production of luteinizing hormone, follicle-stimulating hormone, gonadotropin-releasing hormone and prolactin. AEDs may modulate hormone release from the hypothalamic-pituitary-gonadal axis and they may alter the metabolism of sex hormones and their binding proteins. Hepatic enzyme-inducing AEDs, such as carbamazepine and phenytoin, may be most clearly linked to altered metabolism of sex steroid hormones, but valproic acid, an enzyme inhibitor, has also been associated with a frequent occurrence of polycystic ovary syndrome and hyperandrogenism in women with epilepsy. Therefore, treatment of epilepsy and selection of AEDs are important for reproductive health in female patients. The aim of the present review is to critically evaluate the recently published data concerning the interactions between sex hormones, epilepsy and AEDs.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of Chieti, Via dei Vestini 5, 66100 Chieti, Italy.
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Meyer RP, Pantazis G, Killer N, Bürck C, Schwab R, Brandt M, Knoth R, Gehlhaus M. Xenobiotics in the limbic system--affecting brain's network function. VITAMINS AND HORMONES 2010; 82:87-106. [PMID: 20472134 DOI: 10.1016/s0083-6729(10)82005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Xenobiotic compounds enter the brain through nutrition, environmentals, and drugs. In order to maintain intrinsic homeostasis, the brain has to adapt to xenobiotic influx. Among others, steroid hormones appear as crucial mediators in this process. However, especially in the therapy of neurological diseases or brain tumors, long-term application of neuroactive drugs is advised. Several clinically important malignancies based on hormonal dysbalance rise up after treatment with neuroactive drugs, for example, sexual and mental disorders or severe cognitive changes. A drug-hormone cross talk proceeding over drug-mediated cytochrome P450 induction predominantly in the limbic system and the blood-brain barrier, consequently altered steroid hormone metabolism, and P450-mediated change of steroid hormone receptor expression and signaling may serve as an explanation for such disorders. Especially, the interplay between the expression of AR and P450 at the blood-brain barrier and in structures of the limbic system is of considerable interest in understanding brain's reaction on xenobiotic treatment. This chapter summarizes present models and concepts on brain's reaction after xenobiotics crossing the blood-brain barrier and invading the limbic system.
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Affiliation(s)
- Ralf P Meyer
- Medizinische Fakultät der Universität Freiburg, Breisacherstrasse 64, Freiburg, Germany
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de Oliva SU, Miraglia SM. Carbamazepine damage to rat spermatogenesis in different sexual developmental phases. ACTA ACUST UNITED AC 2009; 32:563-74. [DOI: 10.1111/j.1365-2605.2008.00898.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Epilepsy is most likely to develop in later life. The burden of this disorder on health-care resources will rise further as the world's population continues to age. Making a secure diagnosis can be challenging because the clinical manifestations of seizures and the differential diagnoses and causes of epilepsy can be different in older individuals compared with younger individuals. Obtaining a reliable account of the events for accurate assessment is particularly important in guiding the appropriate choice and interpretation of investigations to arrive at the correct diagnosis. In older age, unique pharmacokinetic and pharmacodynamic changes occur. The use and selection of antiepileptic drugs is often further complicated by the presence of comorbidities, polypharmacy, and concomitant functional impairment, but there is a paucity of high-level clinical evidence on the effects of these factors as well as on the choice of treatment in the elderly. A comprehensive model of care should combine expertise in the diagnosis and treatment of epilepsy with effective assessment and management of the psychosocial effects to improve the prognosis in this vulnerable and poorly studied group of patients.
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Killer N, Hock M, Gehlhaus M, Capetian P, Knoth R, Pantazis G, Volk B, Meyer RP. Modulation of androgen and estrogen receptor expression by antiepileptic drugs and steroids in hippocampus of patients with temporal lobe epilepsy. Epilepsia 2009; 50:1875-90. [DOI: 10.1111/j.1528-1167.2009.02161.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Saletti V, Canafoglia L, Cambiaso P, Russo S, Marchi M, Riva D. A CDKL5 mutated child with precocious puberty. Am J Med Genet A 2009; 149A:1046-51. [DOI: 10.1002/ajmg.a.32806] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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19
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Meyer RP, Gehlhaus M, Schwab R, Bürck C, Knoth R, Hagemeyer CE. Concordant up-regulation of cytochrome P450 Cyp3a11, testosterone oxidation and androgen receptor expression in mouse brain after xenobiotic treatment. J Neurochem 2009; 109:670-81. [DOI: 10.1111/j.1471-4159.2009.05994.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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20
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Affiliation(s)
- Jacqueline A French
- Department of Neurology, New York University School of Medicine, New York, USA.
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22
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Klose M, Feldt-Rasmussen U. Does the type and severity of brain injury predict hypothalamo-pituitary dysfunction? Does post-traumatic hypopituitarism predict worse outcome? Pituitary 2008; 11:255-61. [PMID: 18404391 DOI: 10.1007/s11102-008-0102-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Several studies have reported a close association between traumatic brain injury (TBI) and pituitary dysfunction, and expert panels have recently proposed recommendations for hormone assessment and replacement for pituitary insufficiency after TBI. Given the high incidence of TBI, identification of reliable predictors is of utmost importance in order to secure a cost-effective screening strategy. It has not yet been possible to identify early hormone alterations as a useful tool for the prediction of long-term post-traumatic hypopituitarism, whereas indicators of increased trauma severity have been reported as predictive in an increasing number of studies. Outcome studies have moreover indicated that post-traumatic hypopituitarism is of clinical significance, which may justify introduction of neuroendocrine screening in TBI. Much larger cohorts are, however, still needed for further evaluation and confirmation of reliable screening markers, and future studies should be designed to ensure a high diagnostic robustness for proper identification of reliable predictors, as the results may be highly dependent on diagnostic pitfalls.
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Affiliation(s)
- M Klose
- Department of Medical Endocrinology, PE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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23
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Abstract
Patients who have epilepsy face many challenges resulting from their illness and have frequent psychiatric comorbidities. Recognition of these disorders is increasing and is having a positive impact on patients' quality of life. Recent recommendations about a new classification system for psychiatric disorders related specifically to epilepsy and based on the relationship of symptoms to seizures, antiepileptic medications, and EEG changes should further research and treatment. Especially insofar psychiatric syndromes specific to epilepsy can be identified, correlation of clinical phenomena with relatively well-understood pathophysiology in epilepsy will allow advances in the understanding of psychiatric illness. This progress should move the treatment of patients who have epilepsy toward a comprehensive biopsychosocial model that focuses on the whole person rather than simply on the disease process.
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Affiliation(s)
- Michael J Marcangelo
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank, Milwaukee, WI 53226, USA.
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24
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Abstract
Epilepsy is a common disorder in childhood. The effects of recurrent seizures and the use of antiepileptic drugs (AEDs) during childhood and adolescence on reproductive endocrine health are poorly defined. We review effects of hormones on epilepsy and vice versa along with the effects of treatment (AEDs) on hormones in children.
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Affiliation(s)
- Adenike Opaleke
- Emory Comprehensive Epilepsy Program, Emory University School of Medicine, The Emory Clinic, Atlanta, GA 30322, USA
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25
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Cramer JA, Gordon J, Schachter S, Devinsky O. Women with epilepsy: hormonal issues from menarche through menopause. Epilepsy Behav 2007; 11:160-78. [PMID: 17662661 DOI: 10.1016/j.yebeh.2007.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 03/10/2007] [Indexed: 10/23/2022]
Abstract
Epilepsy is a multilayered disorder complicated by numerous comorbid conditions and hormonal changes. More than 1.5 million girls and women with epilepsy face side effects that are compounded at different ages by menstruation, fertility, pregnancy, fetal health, bone health, and other health issues. Changes in hormonal balance during maturation, from menarche through menopause, affect seizure thresholds and antiepileptic drugs, and vice versa. This overview provides physicians with a background on the multiple issues relevant to women of all ages in the reproductive years, including those planning to conceive and those who are pregnant, and beyond the childbearing years.
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Affiliation(s)
- Joyce A Cramer
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT 06516, USA.
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26
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Stephen LJ, Sills GJ, Leach JP, Butler E, Parker P, Hitiris N, Leach VM, Wilson EA, Brodie MJ. Sodium valproate versus lamotrigine: A randomised comparison of efficacy, tolerability and effects on circulating androgenic hormones in newly diagnosed epilepsy. Epilepsy Res 2007; 75:122-9. [PMID: 17553671 DOI: 10.1016/j.eplepsyres.2007.04.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 03/20/2007] [Accepted: 04/26/2007] [Indexed: 11/23/2022]
Abstract
We have performed a randomised, prospective study to compare the efficacy and tolerability of sodium valproate (VPA) and lamotrigine (LTG) monotherapy, and their effects on circulating androgenic hormones, in newly diagnosed epilepsy. A total of 225 patients (116 male; median age 35 years, range 13-80 years) were followed-up at 6-weekly intervals until they reached an end-point (12 months' seizure freedom; withdrawal due to intolerable side-effects; lack of efficacy despite adequate dosing). Twelve month seizure-free rates were identical (47%) in the VPA (n=111) and LTG (n=114) treatment arms. More patients taking VPA withdrew from the study due to adverse events (26 VPA versus 15 LTG; p=0.046). Eight patients, all taking VPA, dropped out during the first 6 months due to weight gain. There were no changes in mean serum concentrations of testosterone, sex-hormone binding globulin and androstenedione or in the free androgen index after 6 or 12 months' treatment with either drug in 112 patients who fulfilled the criteria for hormone analysis. No difference in efficacy was found between VPA and LTG in our patients with newly diagnosed epilepsy. LTG appeared to be better tolerated. Neither drug appeared to alter the circulating levels of androgenic hormones.
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Affiliation(s)
- Linda J Stephen
- Epilepsy Unit, University Division of Cardiovascular & Medical Sciences, Western Infirmary, Glasgow G11 6NT, Scotland, UK
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27
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Gehlhaus M, Schmitt N, Volk B, Meyer RP. Antiepileptic Drugs Affect Neuronal Androgen Signaling via a Cytochrome P450-Dependent Pathway. J Pharmacol Exp Ther 2007; 322:550-9. [PMID: 17505019 DOI: 10.1124/jpet.107.120303] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recent data imply an important role for brain cytochrome P450 (P450) in endocrine signaling. In epileptic patients, treatment with P450 inducers led to reproductive disorders; in mouse hippocampus, phenytoin treatment caused concomitant up-regulation of CYP3A11 and androgen receptor (AR). In the present study, we established specific in vitro models to examine whether CYP3A isoforms cause enhanced AR expression and activation. Murine Hepa1c1c7 cells and neuronal-type rat PC-12 cells were used to investigate P450 regulation and its effects on AR after phenytoin and phenobarbital administration. In both cell lines, treatment with antiepileptic drugs (AEDs) led to concomitant up-regulation of CYP3A (CYP3A11 in Hepa1c1c7 and CYP3A2 in PC-12) and AR mRNA and protein. Inhibition of CYP3A expression and activity by the CYP3A inhibitor ketoconazole or by CYP3A11-specific short interfering RNA molecules reduced AR expression to basal levels. The initial up-regulation of AR signal transduction, measured by an androgen-responsive element chloramphenicol-acetyltransferase reporter gene assay, was completely reversed after specific inhibition of CYP3A11. Withdrawal of the CYP3A11 substrate testosterone prevented AR activation, whereas AR mRNA expression remained up-regulated. In addition, recombinant CYP3A11 was expressed heterologously in PC-12 cells, thereby eliminating any direct drug influence on the AR. Again, the initial up-regulation of AR mRNA and activity was reduced to basal levels after silencing of CYP3A11. In conclusion, we show here that CYP3A2 and CYP3A11 are crucial mediators of AR expression and signaling after AED application. These findings point to an important and novel function of P450 in regulation of steroid hormones and their receptors in endocrine tissues such as liver and brain.
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Affiliation(s)
- Marcel Gehlhaus
- Pathologisches Institut, Abt. Neuropathologie, Neurozentrum, Universität Freiburg, Freiburg, Germany
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28
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Vulliemoz S, Dahoun S, Seeck M. Bilateral temporal lobe epilepsy in a patient with Turner syndrome mosaicism. Seizure 2007; 16:261-5. [PMID: 17182261 DOI: 10.1016/j.seizure.2006.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 11/06/2006] [Accepted: 11/13/2006] [Indexed: 10/23/2022] Open
Abstract
Turner's syndrome (TS), resulting from deletion of one X chromosome in women, is associated with cerebral development abnormalities, particularly in the temporal lobes. Symptomatic epilepsy is described only in cases with extensive malformations. Here, we report the first case of bilateral temporal epilepsy without macroscopic cerebral malformation in a woman with TS mosaicism. Bitemporal dysfunction was confirmed by the ictal and interictal EEG, PET, MR-spectroscopy and the neuropsychological examination, other causes than TS mosaicism were excluded. In rare cases, TS mosaicism may underlie non-lesional temporal lobe epilepsy, probably in relation to microanatomic structural and functional cerebral abnormalities. Further studies are needed to determine the frequency of this association.
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Affiliation(s)
- S Vulliemoz
- Department of Neurology, University Hospital of Geneva, Switzerland.
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29
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Hamed SA, Hamed EA, Shokry M, Omar H, Abdellah MM. The reproductive conditions and lipid profile in females with epilepsy. Acta Neurol Scand 2007; 115:12-22. [PMID: 17156261 DOI: 10.1111/j.1600-0404.2006.00740.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore the reproductive conditions in women with epilepsy. METHODS Eighty-eight women were included; 37.5% and 62.5% had generalized and partial epilepsies, respectively. Ovarian sonogram, reproductive hormone and lipid profiles were assessed. RESULTS Compared with the control group and in accordance with our laboratory reference values, irregular menses and polycystic ovaries (PCO(s)) were reported in 70.5% and 39.8% versus 21.7% and 16.7% of controls. Abnormalities in leutinizing hormone (LH), follicle-stimulating hormone (FSH), LH-to-FSH ratio, testosterone (T) and prolactin (PRL) were identified. High values of FSH, LH and FSH-to-LH ratio were common with carbamazepine while that of T and PRL were common in untreated patients and with valproate. Low levels of high-density lipoprotein cholesterol was identified in approximately 59% but neither associated with duration and type of antiepileptic drugs nor patients' age, hormonal profile or PCO(s). Significant correlation was identified between menatrual irregularities, T, PRL, hormonal, lipid profile alterations, PCO(s) and seizure frequency but neither with epilepsy type nor focus. CONCLUSION This is the first study in our country that aimed at evaluation of reproductive conditions in women with epilepsy. This study indicates that reproductive dysfunction is common, hence, characterization of seizure-associated neuroendocrine adverse effects is important while managing women particularly during choice of antiepileptic medications as initial step and during patients' follow-up.
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Affiliation(s)
- S A Hamed
- Department of Neurology, Assiut University, Assiut, Egypt.
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30
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Abstract
Psychotropic drugs are often associated with sexual dysfunction. The frequency of antidepressant-associated sexual dysfunction is greatly underestimated in clinical trials that rely on patient self-report of these adverse events. Direct inquiry reveals that delayed orgasm/ejaculation occurs in >50% and anorgasmia in at least one third of patients given selective serotonin reuptake inhibitors. Antidepressant-induced sexual dysfunction can be successfully managed. A different antidepressant without significant sexual effects, such as bupropion or mirtazapine, can often be substituted. Other strategies involve drug holidays or adjunctive therapy with drugs such as sildenafil. Dopamine antagonist antipsychotic drugs are most commonly associated with decreased libido. The newer atypical antipsychotics, with less effect on dopamine, are less commonly associated with sexual dysfunction. Sexual dysfunction is commonly reported with seizure disorders, and many anticonvulsant drugs affect levels of sex hormones. Because sexual dysfunction can be related to many factors, care must be taken to establish the patient's baseline sexual functioning before the initiation of psychotropic drug therapy and to rule out other etiologies before drugs are implicated as causative.
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Affiliation(s)
- Glen L Stimmel
- University of Southern California, School of Pharmacy, Los Angeles, CA 90089-9121, USA.
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