Neuroactive Reproductive Steroid Changes in Men with Epilepsy: Associations with Sexual Function and Potential Implications for Neuronal Excitability.
Abstract number :
J.03
Submission category :
Year :
2001
Submission ID :
620
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
A.G. Herzog, M.D., M.Sc., Neurology, Beth Israel Deaconess Medical Center, Boston, MA; C.A. Frye, Ph.D., Psychology, Biology,& Ctr for Neuroscience Res., The University at Albany-SUNY, Albany, NY; F.W. Drislane, M.D., Neurology, Beth Israel Deaconess Medi
RATIONALE: Reproductive endocrine disorders are unusually common in men with epilepsy (MWE) and have been attributed to enzyme inducing antiepileptic drug (EIAED) use and epilepsy. Reproductive steroids may affect seizures as well as sexual function. Testosterone, a potent androgen, is readily aromatized to estradiol which generally has neuroexcitatory effects. Testosterone can also be reduced to androstanediol which has potent GABAergic inhibitory effects. Dehydroepiandrosterone-sulfate (DHAS) is a weak androgen that nevertheless has potent neuroexcitatory effects. This investigation compared reproductive hormone levels, ratios, and sexual function among treated and untreated men with localization-related epilepsy (LRE) and normal controls.
METHODS: The subjects were 38 men with LRE (30 on enzyme-inducing AED[ssquote]s and 8 who had never been treated or were off AED[ssquote]s for over 6 months) and 18 normal controls, between 18-50 years of age. Pituitary (LH- luteinizing hormone) and gonadal (bioactive-BA estradiol- E2 and testosterone- T, dihydrotestosterone- DHT, androstanediol- A-Diol) hormone levels were assayed. Various androgen/estrogen ratios and a measure of gonadal efficiency, BAT/LH, were determined. Sexual function was assessed using a standardized questionnaire (S-score).
RESULTS: DHAS and BAT were lower, BAE2 was no different, and DHT and A-Diol were higher in MWE regardless of current treatment. BAT/BAE and A-Diol/E2 ratios were higher in MWE regardless of current treatment. SHBG was higher, and DHAS, as well as BAT/LH ratios, were lower in treated than in untreated MWE or controls, reflecting AED effects.[table]BAT levels showed significant correlation with S-scores (p = .02) and inverse correlation (p [lt] .01)with age among MWE, but not among controls.
CONCLUSIONS: The findings support 1) a relationship between BAT levels and sexual function among MWE, 2) reduced gonadal efficiency among MWE who use EIAED[ssquote]s, 3) premature reproductive endocrine decline among MWE 4) changes in ratios of reproductive steroids that may potentially influence neuronal excitability and seizures.
Support: GlaxoWellcome