Effects of levetiracetam monotherapy on sperm parameters and sex hormones: Data from newly diagnosed patients with epilepsy

Ceylan, Mustafa; Yalçın, Ahmet; Bayraktutan, Omer Faruk; Karabulut, İbrahim; Sonkaya, Ali Rıza

doi:10.1016/j.seizure.2016.06.001

Cited by 19 publications

(16 citation statements)

References 41 publications

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“…Post-treatment re-evaluation point was determined if 8 weeks have passed after the last seizure attacks, and if seizures occurred, we waited for another 8 weeks [2], that is, to exclude the effect of epileptic discharges on sex hormones [7].…”

Section: Laboratory Investigationsmentioning

confidence: 99%

“…Epilepsy is a chronic neurological disorder characterized by recurrent epileptic attacks, and researches have reported that the relationship between epilepsy and the reproductive dysfunction is not yet completely understood [1]. Seizures are linked with sexual dysfunction as part of the disease pathophysiology in these patients [2]. Through epileptic discharge, the hypothalamus receives signals from the hippocampus, amygdala, and cerebral cortex.…”

Section: Introductionmentioning

confidence: 99%

“…Also animal studies concerning the effects of LEV on sex hormones concluded that LEV might affect steroid hormone secretion. However, human studies yielded diverse results [2].…”

Section: Introductionmentioning

confidence: 99%

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Effect of valproate versus levetiracetam monotherapy on reproductive functions in newly diagnosed epileptic males

Mohamed

Nageeb

Hashim

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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Background: Antiepileptic drugs are responsible for reproductive dysfunction in male epileptic patients. Objectives: To evaluate the effect of valproate (VPA) versus levetiracetam (LEV) as a monotherapy on males' sex hormones and sperm parameters in newly diagnosed epileptic patients. Materials and methods: This comparative study included 50 newly diagnosed epileptic male patients. All patients were subjected to complete general and neurological examination, Doppler ultrasonography of the testis, pre-and post-treatment serum sex hormone assay, and semen analysis. Post-treatment re-evaluation checkpoint was determined if 8 weeks have passed after the last seizures. This study included two groups, group I (25 patients were treated by VPA) and group II (25 patients were treated by LEV). Results: There was no statistical difference between groups regarding their baseline characteristics. In group I, at post-treatment checkpoint, we found significant decrease in luteinizing hormone and follicle-stimulating hormones and highly significant increase of prolactin serum level. In sperm parameters, there was significant decrease of all measured items. In group II, serum sex hormone was not significantly changed at post-treatment checkpoint but semen analysis parameters were significantly decreased regarding all items. In comparison between the two groups, there was significant decrease of sperm concentration among group II with highly significant decrease of normal morphology of sperm among group I. Conclusion: Both VPA and LEV had adverse effects on the semen of male epileptic patients while VPA had also an adverse effect on sex hormones.

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Section: Laboratory Investigationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of valproate versus levetiracetam monotherapy on reproductive functions in newly diagnosed epileptic males

Mohamed

Nageeb

Hashim

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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show abstract

“…Total serum testosterone levels may be low or may not change, and therefore serum monitoring of testosterone levels for testosterone dosing should be performed, measuring free levels in transmen who take an EI‐AED. Although levetiracetam can affect sperm parameters, testosterone levels are not lowered and may be increased …”

Section: Epilepsy‐specific Considerationsmentioning

confidence: 99%

“…Although levetiracetam can affect sperm parameters, testosterone levels are not lowered and may be increased. 20,21 With the cessation of menstruation, transmen who had catamenial exacerbations of seizure frequency may experience an improvement in seizure control. Testosterone and androgens have primarily anticonvulsant effects; however, because testosterone is metabolized to 17-b-estradiol (with proconvulsant activity), the effects are more mixed.…”

Section: Transmen (Female-to-male [Ftm] Transgender Persons)mentioning

confidence: 99%

Caring for transgender patients with epilepsy

Johnson

Kaplan

2017

Epilepsia

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New valproate regulations, informed choice and seizure risk

Angus-Leppan,

Arkell,

Watkins

et al. 2024

J Neurol

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Valproate is the most effective medication for generalised epilepsies, and several specific epilepsy syndromes. For some people, it will be the only medication to establish seizure remission, and withdrawing it carries risks of seizure recurrence and Sudden Unexpected Death in Epilepsy (SUDEP). It is also of proven efficacy for bipolar disorder and migraine prevention. Guidelines based on observational and epidemiological studies stress that maternal valproate related teratogenicity and neurodevelopmental effects are significantly higher than for other antiseizure medications (ASMs). It should, therefore, only be used if other medications are ineffective and after balancing the teratogenicity risk. Regulatory restrictions have changed prescribing practices and reduced valproate use. The number of other medications that must be trialled in the different conditions for which valproate has effectiveness and the consequences of the lack of efficacy of those drugs leading to significant harm including death remains unexplored. Risk minimisation measures (RMMs) for valproate, chiefly Pregnancy Prevention practices (PPP), consider foetal risk and not risk to people living with epilepsy. In the United Kingdom (UK), limitations relating to valproate use in all people < 55 years commenced in January 2024. While the evidence in child-bearing women is not disputed, the data in males are based on animal models, case reports, and one commissioned, unpublished, non-peer reviewed report unavailable to the UK public, stakeholder charities or professionals. Evidence suggests that 30–40% of people switching from valproate have breakthrough seizures. Thus, an estimated 21,000–28000 people in the UK will imminently be exposed to the potential hazards of breakthrough seizures, including death. There is little government investment in monitoring the effects of these changes to valproate prescribing on patient health and quality of life. This review summarises the history of valproate regulation, evidence underpinning it and argues how the latest regulations in the UK do not align with the country’s medical regulatory bodies ethical principles nor with the Montgomery principles of informed patient choice and autonomy. It dissects how such regulations infringe Common Law principles, nor give due regard for patient outcomes beyond reproduction. The paper looks to provide recommendations to redress these concerns while appreciating the core need for such governance to emerge in the first place.

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Effects of levetiracetam monotherapy on sperm parameters and sex hormones: Data from newly diagnosed patients with epilepsy

Abstract: Our findings confirm that LEV treatment of newly diagnosed epilepsy patients decreases sperm parameters without altering sex hormone levels. Our results may guide the choice of anti-epileptic drug treatment among men with epilepsy.

Cited by 19 publications

References 41 publications

Effect of valproate versus levetiracetam monotherapy on reproductive functions in newly diagnosed epileptic males

Effect of valproate versus levetiracetam monotherapy on reproductive functions in newly diagnosed epileptic males

Caring for transgender patients with epilepsy

New valproate regulations, informed choice and seizure risk

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