Hormonal and sexual disorders in epilepsy

Disorders of reproduction are unusually common among people with epilepsy. They are generally associated with and may be the consequence of reproductive endocrine disorders. Epilepsy itself and epileptic seizures have been implicated in the pathophysiology. Fertility is lower in both men and women with epilepsy than in the general population. Temporolimbic dysfunction in epilepsy may disrupt normal neuroendocrine regulation and promote the development of reproductive endocrine disorders. The particular nature of the dysregulation may relate to the laterality and focality of the epilepsy and some hormonal changes may develop in close temporal relation to the occurrence of epileptiform discharges. In women, reproductive endocrine disorders include polycystic ovary syndrome, hypothalamic amenorrhea, functional hyperprolactinemia, and premature menopause. The use of valproic acid (VPA) is associated with a frequent occurrence of reproductive endocrine disorders characterized by polycystic changes in the ovaries, high serum testosterone concentrations (hyperandrogenism) and menstrual disorders. In men, hypogonadism may be hypogonadotropic, hypergonadotropic and changes of the quality of the spermatozoa have been observed. The endocrinal effects of new antiepileptic drugs (AEDs) have not been widely studied; however, it seems that they may be an alternative if reproductive endocrine problems emerge during treatment with older antiepileptic drugs. The use of the liver enzyme-inducing AEDs phenobarbital, phenytoin and carbamazepine increases serum sex hormone-binding globulin (SHBG) concentrations in both men and women with epilepsy. Over time the increase in serum SHBG levels leads to diminished bioactivity of testosterone and estradiol, which may result in diminished potency in men and menstrual disorders in some women and thus, reduced fertility. © 2018, The Author(s).