Seizure frequency and sex steroids in women with partial epilepsy on antiepileptic therapy

Abstract

SUMMARYPurpose: Neuroactive sex steroids influence neuron excitability, which is enhanced by estradiol (E2) and decreased by progesterone (Pg). In epilepsy, the production, metabolism, biologic availability, and activity of sex hormones may be affected by seizures themselves or by antiepileptic drugs (AEDs). This cross-sectional observational study was aimed at evaluating the relationships between sex steroids, seizure frequency, and other clinical parameters in women with partial epilepsy (PE) on AED treatments. Methods: Serum E2, Pg, sex hormone binding globulin (SHBG) levels, free E2 (fE2), and E2/Pg ratios were determined during the follicular and luteal phases in 72 adult women with PE, and in 30 healthy controls. Hormonal data were correlated with seizure frequency, age, body weight, body mass index (BMI), disease onset and duration, and AED therapies.Results: In patients, E2, fE2, and Pg levels were lower in both ovarian phases, whereas those of SHBG were higher than in controls. No significant changes in hormone levels and in prevalence of anovulatory cycles were observed between patients grouped according to their seizure frequency. However, when compared with those in healthy controls, luteal fE2 and Pg levels were chiefly impaired in women with more frequent seizures, mostly undergoing AED polytherapies, but not in those with absent or rarer seizures. Conclusions: The actual changes in sex steroid levels and E2/Pg ratios did not explain an increased seizure frequency in adult women with AED-treated PE, but patients with more severe disease showed more relevant changes in their sex hormone profile and impaired Pg levels during the luteal phase.

Neuroendocrine considerations in the treatment of men and women with epilepsy

“…56 Several other reports invoke the role of hormones as a contributor to seizure occurrence and cyclic seizure patterns, including the seizure risk imparted by anovulatory cycles, in women with epilepsy. 57–59 Therefore, both oestrogen and progesterone cycling have been associated with patterns of seizure occurrence in catamenial epilepsy.…”

A Cohort Study Comparing Women with Autism Spectrum Disorder with and without Generalized Joint Hypermobility

“…In spite of the previously reported relationship between hormones and seizure propensity, the presence of complex hormonal exophenotypes was not associated with epilepsy in our cohort ( W = 274, unadj. p = 0.3742) [ 32 ]. However, despite the small number of women reporting epilepsy ( N = 7), epilepsy shared a modest positive relationship with the number of immune-mediated disorders irrespective of the group ( W = 166, unadj.…”

Epilepsy , Antiepileptic Drugs and Depression : A Triangle of Danger for Sexual and Reproductive Functions in Females

“…Murialdo et al (22), (2009) found patients with more severe disease showed more relevant changes in their sex hormone profile and impaired progesterone levels during the luteal phase. Pack (23) reported that women with epilepsy have a higher than expected prevalence of sexual and reproductive dysfunction, the epilepsy syndrome and localization influence the presentation of these dysfunctions and specific AED influence the presentation of reproductive dysfunction.…”