Hormones and epilepsy

The complex interactions of neurosecretions with the developing brain suggest that it has multiple site and time-specific vulnerabilities that may contribute to the pathogenesis of several forms of epilepsy, yet, on the other hand, may provide several new forms of therapy. Catamenial seizures can be clearly related to hormonal changes, although other factors are important, such as altered drug metabolism during menses. Progesterone appears to be especially effective in treating seizures. Optimal forms of treatment for catamenial epilepsy have not been established; however, several forms of progesterone are available and may be helpful, including those in oral contraceptives. Special care in the selection of oral contraceptives may be an important adjunct in caring for women with epilepsy. Altered secretion of neurohormones suggests important clues to the sexual dysfunction and psychopathology associated with temporal lobe epilepsy. New approaches to these patients include the clinical evaluation for sexual dysfunction along with the measurement of prolactin, testosterone, LH, and FSH levels, and treatment of sexual dysfunction by the effective use of anticonvulsants. Elevated plasma hormones (especially prolactin) following seizures can help to distinguish true seizures from pseudoseizures. Effects of anticonvulsant drugs on endocrine function are important, particularly with respect to their ability to lower the efficacy of oral contraceptives by competitive binding. A number of hormonal changes have been described with several drugs, which suggest that their complex central and peripheral effects might help to explain some aspects of normal hormone activity as well as some common side effects of the drugs.