Abstracts

Rationale: It is known that in women with epilepsy (WWE) the epileptic syndrome, seizure frequency and antiepileptic drugs may affect reproductive function. Several factors are associated with these changes, such as: longer epilepsy duration, severity of epilepsy, use of valproate, and temporal lobe epilepsy. Based on the knowledge acquired with studies in women, it is assumed that female adolescents suffer similar influences. Although there is robust data on WWE, to the moment, there is no study evaluating fertility in adolescents with epilepsy (AWE). This study aimed to evaluate fertility (gonadal function) in AWE and to determine whether epilepsy variables may affect gonadal function (GF) in AWE. Methods: We prospectively studied 35 AWE, with ages between 10 and 20 years (mean 16.1 y; SD±2,28 y), with partial and generalized epilepsies, classified according to ILAE criteria (1989). Criteria of exclusion were: patients that had not yet had their menarche, those in use of hormonal contraceptives or intrauterine devices; patients with previous gynecological surgery or endocrinological disorders; presence of chronic disease other than epilepsy; and moderate to severe mental retardation. Our study protocol for GF included analysis of clinical criteria such as: recent or ongoing pregnancy, regular menstrual cycles and presence of dysmenorrhea. Ancillary exams comprised hormonal levels, with emphasis on FSH in the first phase of the cycle and on progesterone in the second phase. A pelvic ultrasound study was obtained weekly. Pregnancy was considered as indicative of normal GF and used as an absolute criterion. Other patients (non-pregnant) had to present two clinical and/ or laboratorial criteria. Results: 28 AWE underwent the protocol, 19 (67.8%) were considered as having normal GF, with 13 pregnant and 06 with clinical and laboratorial findings. One patient (3.5%) had abnormal GF due to the presence of polycistic ovarian syndrome, caused by valproic acid. In five patients, without lab results (17,8%), clinical data (presence of dysmenorrhea and regular menstrual cycles) were suggestive of normal GF. In three patients (10,9%), clinical data were suggestive of abnormal GF. Therefore, from 28 patients with conclusive evaluations of GF, twenty-four (85,6%) presented clinical data suggestive of normal GF. Age of menarche was similar in both groups, but the use of valproate close to menarche and frequent seizures were factors that anticipated this event. Moreover, AWE presented irregular menstrual cycles more frequently than controls. Menstrual irregularity was related to the presence of tonic-clonic generalized seizures (p=0.02), regardless the epilepsy type or syndrome, and with longer disease duration (p=0.06), independently of seizure frequency. Higher rates of pregnancy were observed in AWE (p<.0001). Conclusions: AWE showed spared GF, in opposition to WWE. However, the presence of a high frequency of menstrual irregularities may indicate that we are facing an ongoing process that might lead to anovulatory cycles and reproductive dysfunction in adulthood. Therefore, GF in AWE requires special attention by health professionals. Grant FAPESP