Serum Hormones in Male Epileptic Patients Receiving Anticonvulsant Medication

Isojärvi, Jouko; Pakarinen, Arto; Ylipalosaari, Pekka; Myllylä, Vilho V.

doi:10.1001/archneur.1990.00530060082023

Cited by 150 publications

(120 citation statements)

References 45 publications

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“…Blank and Joffe (33,45) suggested that CBZ may alter thyroid hormone levels affecting directly TSH or TRH, but our data do not support this possibility. In agreement with other authors (5,19,26), TSH levels do not increase in CBZ-treated patients, the cause is not activated by the positive feedback mechanism, which should result from low serum thyroid hormone concentrations and serum thyroid hormone levels remain low. Moreover, TRHstimulated secretion of TSH is not increased during CBZ medication.…”

Section: Discussionsupporting

confidence: 92%

“…Valproic acid (VPA) has also been found to be an effective antiepileptic drug (AED) in epilepsy (3,4). Although these AEDs are well tolerated, many effects on endocrine function have been reported in literature (5)(6)(7)(8). The effect of these two AEDs on serum thyroid hormone concentrations has been controversial: CBZ therapy can decrease the serum thyroid hormone levels, but generally serum thyrotropin-releasing hormone (TSH) concentrations remain normal except in a small percentage of patients who show increased TSH levels (9,12).…”

Section: Introductionmentioning

confidence: 99%

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Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate

Verrotti

Laus

Sereno

et al. 2009

European Journal of Endocrinology

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Objective: This study evaluates the effects of long-term carbamazepine (CBZ) and valproate acid (VPA) therapy on thyroid function in epileptic children. Design: A prospective study performed in 32 newly diagnosed pediatric patients, subdivided into two groups: 18 patients treated with CBZ and 14 patients treated with VPA. Thirty-two sex-and agematched subjects served as controls. Methods: Serum TSH, thyroxine (T 4 ), triiodothyronine (T 3 ), free thyroxine (fT 4 ), free triiodothyronine (fT 3 ), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (TG-Ab) were evaluated at baseline and at the 3rd, 6th, and 12th month in all patients and in the control group. A TRH stimulation test was performed in all epileptic patients at baseline and at the 3rd, 6th, and 12th month evaluations while in controls only baseline assessment was carried out. Results: At baseline evaluation, thyroid function was normal in all epileptic children. After 3 months, CBZ-treated patients showed serum T 4 and fT 4 levels significantly lower than baseline evaluation and control subjects. Serum T 4 and fT 4 concentrations were unaffected by VPA monotherapy. Serum T 3 and fT 3 were normal in both CBZ-treated and VPA-treated patients. TRH test was normal in all patients. At 6th and 12th month evaluations, the same alterations were present in CBZ-treated patients while thyroid function remained normal in VPA-treated patients. TRH test responses were normal in all epileptic patients. TPO-Ab and TG-Ab were always absent in all patients. Conclusions: Our data suggest that VPA monotherapy does not alter thyroid hormones. On the contrary, alterations of thyroid hormones occur in CBZ-treated children. However, the patients are euthyroid and thyroid hormone alterations are not associated with clinical or subclinical hypothyroidism.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate

Verrotti

Laus

Sereno

et al. 2009

European Journal of Endocrinology

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“…CBZ slows the conduction velocity of both central and peripheral nerves (31,32). Furthermore, CBZ can also modify endocrine secretion at the hypothalamicpituitary level (33,34), indicating that the drug may affect central regulation of the hypothalamic function. Although the specific events leading to sudden unexplained death in patients with epilepsy still remain to be established, cardiac arrhythmias due to increased sympathetic activity have been considered the most likely cause (1,9).…”

Section: Age [Years]mentioning

confidence: 99%

Interictal Cardiovascular Autonomic Responses in Patients with Epilepsy

et al. 1998

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Summary: Purpose: To evaluate the interictal autonomic nervous system function in 84 patients with epilepsy: 37 with newly diagnosed, previously untreated epilepsy, and 47 patients receiving long-term carbamazepine (CBZ), phenytoin (PHT), or valproate (VPA) monotherapy, or CBZ plus PHT, or CBZ plus VPA for their seizure disorder. Methods:We assessed autonomic control of the cardiovascular regulatory system.by standardized cardiovascular reflex tests measuring changes in heart rate (HR) and blood pressure (BP) at rest and after certain stimuli.Results: The HR and BP responses were similar to those of control subjects in patients with newly diagnosed epilepsy. However, HR variation during normal breathing and maximum systolic BP increase in isometric work were diminished in patients, who had been treated with antiepileptic drugs (AEDs) for epilepsy for a long time. Diminished H R responses to the Valsalva maneuver were noted in patients receiving CBZ as monotherapy and during deep breathing in patients receiving CBZ combined with PHT or VPA. Furthermore, patients re-ceiving CBZ had diminished BP responses in isometric work.When analyzed in relation to epilepsy type, suppressed HR responses in normal breathing were associated with primary generalized epilepsy (PGE), whereas diminished BP responses in isometric work were associated with partial epilepsy. Two patients with recently diagnosed partial epilepsy and 1 patient receiving long-term CBZ monotherapy for partial epilepsy had two abnormal cardiovascular response test results. Conclusions:Our results show that cardiovascular responses mediated by both the parasympathetic and sympathetic nervous system are diminished in patients with epilepsy. However, the changes appear to be clinically significant in only a few of them and appear to be associated with CBZ medication. Further studies are needed to detect the underlying complex interactions and clinical significance of autonomic nervous system dysfunction in patients with epilepsy.

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“…Previous studies 12,15,17,18,[28][29][30] showed high serum levels of SHBG in patients treated with AEDs. Increased SHBG would expect to produce sexual dysfunction by decreasing serum levels of free-T and/or albumin-bound testosterone, which was indirectly estimated by FAI in this study.…”

Section: Discussionmentioning

confidence: 91%

“…While some studies implicate low serum levels of free-T as the cause of hyposexuality [12][13][14][15][16] , other studies 17,18 found normal serum levels of free-T, increased SHBG, and reduced FAI in patients with epilepsy and hyposexuality. The majority of studies investigated sexual function in patients with refractory epilepsy, particularly those can-didates to temporal lobe surgical resection.…”

mentioning

confidence: 99%

Interictal hyposexuality in male patients with epilepsy

Silveira

Souza

Carvalho

et al. 2001

Arq. Neuro-Psiquiatr.

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-The purpose of this study was to compare the serum levels of androgens between hyposexual and non-hyposexual patients with epilepsy. Adult male patients with epilepsy were investigated. Serum levels of testosterone (T) and free-T, estradiol, and sex hormone binding globulin (SHBG) were measured and the free androgen index (FAI) was calculated. While there were no differences between hyposexual and non-hyposexual patients in the serum levels of T, free-T, and estradiol, or to the FAI, the serum levels of SHBG were significantly higher in hyposexual patients than in non-hyposexual patients. Thus, the effects of increased SHBG upon serum levels of testosterone biologically active in patients with epilepsy and hyposexuality were not detected by the methods used in this study. Four (44%) of nine hyposexual patients who were re-evaluated after two years follow-up improved sexual performance. Thus, clinical treatment that results in good seizure control may improve sexual performance in some patients with epilepsy.KEY WORDS: epilepsy, sexual dysfunction, testosterone, and androgens.Hipossexualidade interictal em homens com epilepsia RESUMO -O objetivo deste estudo foi comparar os níveis séricos de andrógenos e estradiol entre pacientes do sexo masculino com e sem hipossexualidade. Níveis séricos de testosterona e testosterona porção livre, estradiol e globulina ligadora de hormônio sexual (SHBG) foram dosados e calculado o índice de andrógeno livre (FAI). Não houve diferença significante de testosterona, porção livre de testosterona, estradiol e de FAI nos pacientes com e sem hipossexualidade. Os níveis de SHBG foram significantemente maiores nos pacientes hipossexuais quando comparados com os pacientes sem hipossexualidade. Deste modo, os efeitos da SHBG aumentada nos níveis séricos de testosterona biologicamente ativa, em pacientes com epilepsia e hipossexualidade, não foram detectados pelo método usado neste estudo. Quatro (44%) pacientes, reavaliados após dois anos de seguimento, tiveram melhora significativa do desempenho sexual. Portanto, o tratamento medicamentoso, com melhor controle das crises epilépticas, pode melhorar o comportamento sexual de alguns pacientes com epilepsia.PALAVRAS-CHAVE: epilepsia, disfunção sexual, testosterona, andrógenos.

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Serum Hormones in Male Epileptic Patients Receiving Anticonvulsant Medication

Cited by 150 publications

References 45 publications

Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate

Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate

Interictal Cardiovascular Autonomic Responses in Patients with Epilepsy

Interictal hyposexuality in male patients with epilepsy

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