SEXUAL DYSFUNCTION, SEX STEROID HORMONE ABNORMALITIES AND DEPRESSION IN WOMEN WITH EPILEPSY TREATED WITH ANTIEPILEPTIC DRUGS
Abstract number :
2.335
Submission category :
Year :
2003
Submission ID :
1939
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Martha J. Morrell, Alison M. Pack, Kerry L. Flynn, Silvia Done, Edith Flaster Neurology, Columbia University, New York, NY; Neurology, Columbia University, New York, NY; Neurology, Columbia University, New York, NY; Neurology, Columbia University, New Yor
Adverse sexual symptoms are reported in 30% of women with epilepsy (WWE). Possible mechanisms for this may include antiepileptic drug (AED) associated changes in sex steroid hormones as well as depression.
We evaluated 57 WWE on AED monotherapy (phenobarbital (PB) = 8, phenytoin (PHT) = 13, valproate (VPA) = 9, gabapentin (GBT) =5, lamotrogine (LTG) =10, carbamazepine (CBZ) =12) and 17 nonepileptic controls aged 18-40. Subjects answered validated inventories assessing sexual functioning, sexual behavior, sexual anxiety, sexual arousability and mood. Fasting serum was obtained for levels of estradiol, free testosterone (T), total T, luteinizing hormone (LH), prolactin, SHBG and DHEAS.
Analysis of variance by drug type using Dunnett[rsquo]s test found significantly lower arousal in WWE receiving PHT and PB when compared to controls (p[lt]0.05). Sexual dysfunction and anxiety was significantly higher in WWE on PHT compared to controls (p[lt] 0.05). Analysis of variance by epilepsy syndrome using Dunnett[rsquo]s test showed significantly lower arousal in women with both PGE and LRE when compared to controls (p[lt]0.05). Women with LRE also had higher depression scores and increased dysfunction than controls.
Pearson correlation analyses were run on the hormones estradiol, free T, total T, LH, prolactin, SHBG, and DHEAS, versus percent dysfunction, sum of the behaviors, average anxiety score, average arousal score, and total Beck depression inventory score. Estradiol negatively correlated with anxiety (p=0.01). DHEAS negatively correlated with sexual dysfunction (p=0.035), and positively correlated with sexual arousal (p=0.049).
WWE on PB and PHT are more likely to have sexual problems as evidenced by arousal insufficiencies, increased sexual dysfunction, and more sexual anxiety. Although women with both PGE and LRE had significantly lower sexual arousal than nonepileptic controls, women with LRE were more depressed and more likely to experience sexual dysfunction. Low estrogen was associated with heightened sexual anxiety, whereas low androgen (DHEAS) was associated with sexual arousal insufficiency and with sexual dysfunction. Sexual symptoms in WWE appear to be related to depression, use of particular AEDs (PHT and PB) and AED associated reductions in sex steroid hormones.
[Supported by: GlaxoSmithKline]