Which antiepileptic drug for men with epilepsy? A critical epileptological and andrological review

Background: Choice of antiepileptic drugs (AED) in the treatment of epilepsy is partly based on the assessment of drug-induced sexual dysfunction in men. We examined current knowledge on the effect of AED on reproductive functions in men with epilepsy.

Methods: Original publications and review articles were evaluated by an epileptologist and a specialist in andrology.

Results: Only few data are available to assess the effects of AED (i.e. carbamazepine, oxcarbazepine, valproate, and lamotrigine) on male sexual function. Moreover, the effect of epilepsy itself is almost never considered. Temporal lobe epilepsy may however influence the release of sexual steroid hormones, resulting in reduced serum concentrations of testosterone. Enzyme-inducing AED increase the amount of testosterone bound to the sexual hormone-binding globulin (SHBG). However a correlation to sexual functions is not well established. In addition, AED may affect spermatogenesis and sperm motility, possibly resulting in infertility.

Conclusions: Based on current data, lamotrigine and valproate are the AED of choice. These AED have little or no effect, respectively, on SHBG and exert no negative effects on sexual steroid hormones in men.