Abstracts

RATIONALE: Women with Epilepsy (WWE) are at risk for endrocrine disorders. Prior research suggests that altered pituitary gonadotropin secretion, specifically luteinizing hormone (LH), is increased in WWE. We hypothesized that pituitary LH release would be differentially affected 1)in women with localization related epilepsies (LRE) and especially those of the temporal lobe origin (TLE) because of altered hypothalamic-pituitary axis function, and 2)according to antiepileptic drugs (AED) effects on hepatic steroid hormone metabolism. Previous research has indicated that elevated LH pulsatility and an elevated LH/Follicle Stimulating Hormone (FSH) ratio are correlated with reproductive disorders such as polycyctic ovarian syndrome. METHODS:LH pulsatile release was evaluated from sera collected every 10 minutes over 8 hours during early follicular phase. Pulses were analyzed using the Cluster Pulse Detection Algorithm. Fasting baseline values of LH and FSH were obtained. RESULTS:Data was obtained from 71 WWE (47 LRE, 24 PGE), aged 18-40 (mean 30.9), receiving AED monotherapy [16 carbamazepine (CBZ), 12 phenytoin (PHT), 11 phenobarbital (PB), 13 valproate (VPA), 14 lamotrigine (LTG), 5 gabapentin (GBT)] and 20 nonepileptic controls. LH pulse frequency was higher in WWE with PGE (6.8, SE 0.4) than LRE (5.7, SE 0.2) p=0.02, and lowest in TLE (4.9, SE 0.4) p<0.01. The LH/FSH ratio was elevated in WWE with PGE (1.083, SE 0.11) compared to LRE (0.828, SE 0.05) p<0.03. When AEDs were grouped by hepatic enzyme effects, there was no difference in LH or LH/FSH ratios. CONCLUSIONS:Abnormal LH pulsatility is associated with epilepsy syndrome, not AED. Altered limbic input to hypothalamus in TLE appears to reduce LH release, whereas LH is increased in PGE, perhaps due to frequent epileptiform discharges. The elevated LH/FSH ratio indicates that disruptions in the hypothalamic-pituitary axis preferentially affect LH rather than all pituitary hormones. This was funded by Glaxo Wellcome, Inc.