Neuroendocrine hormonal conditions in epilepsy: relationship to reproductive and sexual functions

Hormones may influence susceptibility to develop seizures. The concept of the interrelation between epilepsy, hormones, and hormonotherapy is currently emerging. On the other hand, epilepsy and its medications are associated with hormonal disturbances resulting in altered endocrine reproduction and sexual functions.

Epilepsy itself may directly influence the endocrine control centers in the brain, the hypothalamic-pituitary axis, thus altering the release of sex steroid hormones including the production of luteinizing hormone, follicle stimulating hormone, gonadotrophin-releasing hormone, and prolactin and the concentrations and metabolism of its end products such as estrogen, testosterone, and dehydroepiandrosterone. Antiepileptic drugs may modulate hormone release from the hypothalamic-pituitary-gonadal axis and may have direct inhibitory effect on reproductive function. They may change steroid sex hormones metabolism and their binding proteins. Reduced fertility and disturbance in various aspects of sexual function are common in men and women with epilepsy. Men with epilepsy may develop delayed sexual development, sperm, and testicular abnormalities. Women with epilepsy may develop menstrual disturbances, weight gain, hyperandrogenism, ovulatory failure, and polycystic ovaries.

Epileptic patients will benefit from regular monitoring of ovarian and testicular functions. Early characterization of reproductive abnormalities encountered in patients with epilepsy will allow neurologists to properly choose and change antiepileptic medications. This will also improve patients' sexual function.