Implications of hormonal and neuroendocrine changes associated with seizures and antiepileptic drugs: a clinical perspective.

Epilepsy and antiepileptic drugs (AEDs) affect hormones and neuroendocrine systems, which may result in a change in the seizure threshold (catamenial epilepsy) or in comorbidities including sexual dysfunction, reproductive dysfunction, and abnormalities in bone health. Catamenial epilepsy occurs commonly in women with epilepsy. The most commonly reported and studied mechanism proposed to explain why some women have a catamenial seizure exacerbation relates to cyclic changes in reproductive steroid hormones. Women and men with epilepsy have a higher than expected prevalence of sexual dysfunction. The epilepsy syndrome and localization influence the presentation of sexual dysfunction. Reproductive dysfunction occurs in both men and women with epilepsy. As with sexual dysfunction both the epilepsy syndrome and specific AEDs influence the presentation of reproductive dysfunction. Persons with epilepsy have an increased risk of fracture secondary to decreased bone mineral density (BMD), altered bone quality, and a propensity to fall because of either seizures or side effects of medication. Some AEDs are associated with abnormalities in BMD and bone and mineral metabolism.