Abstracts

Androgens play an important role in sexual function. They also have metabolites with potent neuroexcitatory (estradiol-E, dehydroepiandrosterone sulfate-DHEAS) and inhibitory (androstanediol) properties that may influence seizure management. We compared serum levels of these neuroactive steroids in men with localization related epilepsy (LRE) on various antiepileptic drugs (AEDs) and normal controls (NC). Subjects were 87 men with LRE [unmedicated [gt] 6 months (No Rx)-12, carbamazepine (CBZ)-25, phenytoin (DPH)-25, lamotrigine (LTG)-25] and 25 NC. Sexual function scores (S-Score), hormone levels [DHEAS, bioactive (BA) testosterone (T), estradiol (BAE) and androstanediol (BAL)] and the ratios of inhibitory to excitatory neuroactive metabolites of T, i.e. BAL/BAE, were compared among groups. S-scores, DHEAS and BAT were significantly (p[lt].05) lower and BAL and BAL/BAE were significantly higher among CBZ and DPH groups than among NC and LTG groups (Table). LTG did not differ from NC in any of these measures. BAT correlated significantly with BAL/BAE for DPH (r = .44, p = .02) and CBZ (r = .42, p = .03) but not for NC (r = .03, p = NS) and LTG (r = .06, p = NS) groups.[table1] In comparison to LTG, enzyme inducing AEDs (CBZ, DPH) are associated with a theoretically more favorable neuroactive steroid balance (lower DHEAS and higher BAL/BAE) for seizure management, but at the expense of reduced serum BAT levels and sexual function which are in the normal range with LTG use. (Supported by GlaxoSmithKline)