Epilepsy & Sexual Dysfunction

Epilepsy, AEDs and reproductive hormonal system have complex interactions. Hormones can affect seizure frequency.on the other hand, both epilepsy and/or AEDs can compromise The reproductive hormonal and sexual functions.reproductive and sexual dysfunction in people with epilepsy are not gender specific,both men and women are affected. Use of AEDs seems to be associated with frequent occurrence of reproductive and sexual problems including diminished potency,polyclystic overian changes hyperandrogenism, menstrual disorders, and reduced fertility. Psychosocial complications associated with epilepsy can also affect reproductive health and sexuality. Regular multidisciplinary evaluation including neurologist, endocrinologist,urologist,gynecologist and psychiatrist is needed while managing patients with epilepsy. Large sample sized longitudinal designed studies and longer lengths of exposure to AEDs may be helpful in characterizing the impact of length and time of exposure effect of AEDs on reproductive function. These studies should include the new AEDs. Furthermore,better understanding of the molecular properties of endocring effects on seizures over a lifetime seems to have a promising therapeutic profile for treatment of epilepsy. HORMONES AND SEIZURES ESTROGEN: The relationship between estrogen and seizures is complex and controversial. A few studies suggest that estrogen has the potential to enhance neuronal excitability and increase seizures. An epileptogenic effect was found when conjugated equine estrogen where applied to the cerebral cortex. Acuted administration of estrogen was found to have a proconvulsant effect in pentylenetetrazole-induced seizures. Elevation of estrogen–to-progesterone ratio has been suggested as a cause of seizure exacerbation during perimentopause and the decrease in seizure frequency. However, many recent studies indicated that estrogen has little beneficial effect on seizure activity. At either physiological or supraphysiological levels. In contrary, other studies showed that estrogens may decrease seizures. In ovarectomized famele rats, B-estradiol can reduce seizures inducted by N-methyl- d-aspartate (NMDA)or kainic acid (KA). A decline in seizure frequency was reposted in some women with primary generalized seizures around the time ovulation and in postmenopausal epileptic women utilizing estrogen as replacement hormonal therapy. On the other hand, strogen has showen a neuroprotective effect from seizure-inducted brain damage. Estrogen has showen to protect hippocampal cells in ka model of epilepsy from glutamate - induced excitotoxicity. pretreatment with B-estradiol was found to prevent cell loss in the dentate gyrus after atatus epilepticus period. Briellmann et al in their study utilizing quantitative magnetic resonance imaging to measure the hemicranial and hippocampal volumes of patients with temporal lobe epilepsy(TLE) reported that females are less vulnerable to seizure-essociated brain damage.the neuroprotective effect has been attributed to its antiapoptosis, antioxidant, and cerebral vasodilator effect with improvement of cerebral blood flow and increasing cerebral glucose utilization. Estrogen directly inhibits NMDA receptors. It upregulates different neurotrophins as neuropeptide Y (NPY). It also activates growth factor signaling pathways in neurons such as mitogen-activated protein kinases and cyclic adenosine monophosphate (AMP)response element binding protein. These controversial data about estrogen effects cloud be related to various variables such as the different species (humans vs animals)the used animal model,sex (males vs famales), hormonal status (naïve vs gonadectomized/ agedanimals), specific region of the brain tested, estrogenic substance (ie,conjugated estrogens have more convulsant effect than B- estradiol) estrogen dose (low vs high dose)and treatment duration and the latency prior to seizure testing (acute vs chronic) .