Weight change associated with valproate and lamotrigine monotherapy in patients with epilepsy

Polycystic ovary syndrome and epilepsy: a review of the evidence

Overrepresentation of polycystic ovary syndrome (PCOS) in women with epilepsy has been described since the early 1980s. While some authors attribute this association to an effect of the seizure disorder on the hypothalamic control of reproductive function, others have reported a relationship with the use of the antiepileptic drug valproic acid (VPA). In this article we review the literature on this complex issue, with a detailed analysis of the different reports which describe the reproductive endocrine assessment in women with epilepsy. In spite of the large number of patients assessed, a clear picture does not emerge, mostly because of the wide variability of methodology employed in the different study projects and of the small size of many patient samples especially when divided in subgroups. However, on the whole these studies suggest that women with epilepsy are at risk for developing reproductive endocrine disorders, even if there is not yet definite evidence that PCOS may be over-represented in these patients nor that VPA may be the cause of endocrine problems. It is likely that both the epileptic disorder and the antiepileptic treatment play different roles in the development of such disturbances. This hypothesis deserves further prospective study in large samples of patients; consistency in methodology, diagnostic criteria and presentation of results should always be encouraged in the researchers dealing with these projects. In the meantime, women with epilepsy should be carefully monitored with regard to menstrual function, bodyweight and hyperandrogenism, and evaluation of these parameters should become part of the routine evaluation in baseline and follow-up consultations.

Reproductive dysfunction in women with epilepsy: recommendations for evaluation and management

BACKGROUND

Epilepsy is commonly associated with reproductive endocrine disorders. These include polycystic ovary syndrome (PCOS), isolated components of this syndrome such as polycystic ovaries, hyperandrogenaemia, hypothalamic amenorrhoea, and functional hyperprolactinaemia.

OBJECTIVE

To summarise the currently known relations between epilepsy and reproductive endocrine disorders.

METHODS

A review of clinical experience and published reports.

RESULTS

The most likely explanations for endocrine disorders related to epilepsy or antiepileptic drugs are: (1) a direct influence of the epileptogenic lesion, epilepsy, or antiepileptic drugs on the endocrine control centres in the brain; (2) the effects of antiepileptic drugs on peripheral endocrine glands; (3) the effects of antiepileptic drugs on the metabolism of hormones and binding proteins; and (4) secondary endocrine complications of antiepileptic drug related weight changes or changes of insulin sensitivity. Regular monitoring of reproductive function at visits is recommended, including questioning about menstrual disorders, fertility, weight, hirsutism, and galactorrhoea. Particular attention should be paid to patients on valproate and obese patients or those experiencing significant weight gain. Single abnormal laboratory or imaging findings without symptoms may not constitute a clinically relevant endocrine disorder. However, patients with these kinds of abnormalities should be monitored to detect the possible development of a symptomatic disorder associated with, for example, menstrual disorders or fertility problems.

CONCLUSIONS

If a reproductive endocrine disorder is found, antiepileptic drug treatment should be reviewed to ensure that it is correct for the particular seizure type and that it is not contributing to the endocrine problem. The possible benefits of a change in treatment must be balanced against seizure control and the cumulative side effect of alternative agents.