Abstracts

Rationale: Hyperandrogenism is more common among women with epilepsy compared to women in the general population, often leading to acne and hirsutism. Spironolactone, an acne and hirsutism treatment, acts as an androgen receptor antagonist, blocking testosterone production and its effects while increasing the aromatization of testosterone to estradiol. Notably, testosterone can affect seizure control via conversion to neurosteroids with anticonvulsant and proconvulsant effects. 5 α-reductase (5-ARI) converts testosterone to dihydrotestosterone, which is then converted to 3α-androstanediol, an allosteric modulator of the GABA-A receptor with anticonvulsant properties. Hence, finasteride, a 5-ARI inhibitor, can increase neuronal excitability by inhibiting the production of anticonvulsant neurosteroids. On the other hand, testosterone is also metabolized via aromatization to 17β-estradiol, which has proconvulsant properties. Aromatase inhibitors can decrease seizure frequency. Our case illustrates how the use of spironolactone has the potential to affect seizures negatively.


Methods: This is a single case report.

Results: A 29-year-old woman presented to the Epilepsy Clinic in follow-up of focal epilepsy of unclear etiology. Semiology was that of déjà vu feeling with nausea, anxiety, and a feeling “as if in a different dimension”, intermittently progressing to impaired awareness. Seizures were historically catamenial with perimenstrual provocation though she no longer menstruated due to IUD use.



At the time of the visit, she reported 5 recent breakthrough focal aware seizures. Seizures started one month after having been started on oral spironolactone at 100 mg daily for severe acne; before this, she had been seizure-free for over a year. Lamotrigine level was 4.8mcg/mL. Lab studies including electrolytes, glycose, white count, and thyroid function were unremarkable. There were no provactive factors and she was complaint with her lamotrigine.



Her dose of lamotrigine was increased to 350 mg of the extended-release formulation. At her subsequent office visit 3 months later, she was seizure-free. Follow-up studies included a lamotrigine level of 7.7mcg/mL, an unremarkable MRI Brain, and a normal awake and drowsy routine EEG.


Conclusions: Young women with epilepsy, particularly temporal lobe epilepsy, may find themselves at the intersection of seizure control with anti-seizure medications and treatment for hyperandrogenism. The effect to which antiandrogen treatments may affect seizure control is not well understood. This case report emphasizes that caution should be exerted when adding oral spironolactone in women with epilepsy as spironolactone holds the potential of negatively affecting seizure control.


Funding: None