ABSTRACT

Reproductive endocrine disorders are more frequent in woman with epilepsy than in the general population. These disorders include polycystic ovary syndrome (PCOS) and its components, oligo-amenorrhoea, hyperandrogenism, polycystic changes in the ovaries, hypothalamic amenorrhoea, and hyperprolactinemia. The etiology of PCOS is complex and includes epilepsy itself, as well as the administration of antiepileptic drugs (AEDs), especially valproate. It has been proposed that epileptic electrical discharges, particularly in the temporolimbic area, alter the secretion of pituitary and gonadal hormones, thus resulting in reproductive dysfunction. AEDs may have a variety of influences on the metabolism of some sex hormones and their binding proteins that may result in secondary complications. In particular, enzyme-inducing antiepileptic drugs, rather than non-EIAEDs (NEIAEDs), seem to be most clearly linked to an altered metabolism of sex steroid hormones. Among NEIAEDs, the effect of valproate can be seen directly in the ovarian androgen product or an inhibition of sex hormone metabolism. Newer antiepileptic drugs, such as oxcarbazepine, lamotrigine, and levetiracetam, do not have prominent side effects on the reproductive system.