El-Khayat Hamed A, Abd El-Basset Fatma Z, Tomoum Hoda Y, Tohamy Saeid M, Zaky Amira A, Mohamed Mervat S, Hakky Suzan M, El Barbary Nancy S, Nassef Nermin M
Department of Pediatrics, Ain Shams University, Cairo, Egypt.
Epilepsia. 2004 Sep;45(9):1106-15. doi: 10.1111/j.0013-9580.2004.66303.x.
This study investigated the effect of epilepsy and/or antiepileptic drugs (AEDs) on the physical growth, pubertal development, and androgenic status of girls with epilepsy between ages 8 and 18 years.
Sixty-six female patients with epilepsy, their mean ages 13.47 +/- 3.5 years, were included. Anthropometric measurements, staging of pubertal maturation, and clinical manifestations of hyperandrogenism were assessed, as well as measurement of serum levels of testosterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), and free androgen index (FAI). Of the included patients, 44 had transabdominal ultrasonic examination of the ovaries and fasting serum insulin levels were measured. Forty healthy age-matched females served as a control group.
Patients showed reduced mean height percentile compared with controls (z = 2.07; p = 0.04), which was negatively correlated with the duration of their epilepsy. Patients showed increased frequency of obesity, especially postpubertal girls taking valproate (VPA; 67%), who also showed higher insulin levels (t = 8.01; p = 0.0003). Patients showed increased frequency of clinical hyperandrogenemia in the different stages of puberty. High levels of testosterone and DHEAS were found in female patients with epilepsy, especially pubertal and postpubertal girls. Hyperandrogenism (clinical and/or laboratory) was most affected by the types of AEDs, with higher incidence in patients taking VPA compared with those taking enzyme-inducing AEDs (chi2= 9.16; p = 0.01). Eighteen percent of the patients were diagnosed as having polycystic ovary syndrome (PCOS). No difference was found in the types of seizures, degree of seizure control, type of AEDs, or insulin levels between patients with and those without PCOS.
Longer duration of the disease has a negative impact on the stature of female patients with epilepsy. Postpubertal girls taking VPA are more liable to obesity, which is associated with increased incidence of hyperinsulinemia. Clinical and/or laboratory evidence of hyperandrogenism is seen at a high frequency in patients, especially with the use of VPA. Furthermore, female patients with epilepsy especially in the postpubertal stage of sexual maturation, have a high prevalence of PCOS, independent of the type of AED or the characteristics of the epilepsy disorder.
本研究调查癫痫和/或抗癫痫药物（AEDs）对8至18岁癫痫女童身体生长、青春期发育及雄激素状态的影响。
纳入66例癫痫女性患者，她们的平均年龄为13.47±3.5岁。评估人体测量指标、青春期成熟分期、高雄激素血症的临床表现，以及血清睾酮、硫酸脱氢表雄酮（DHEAS）、性激素结合球蛋白（SHBG）和游离雄激素指数（FAI）的测定。在所纳入的患者中，44例接受了经腹卵巢超声检查并测量了空腹血清胰岛素水平。40名年龄匹配的健康女性作为对照组。
与对照组相比，患者的平均身高百分位数降低（z = 2.07；p = 0.04），这与癫痫病程呈负相关。患者肥胖发生率增加，尤其是青春期后服用丙戊酸（VPA）的女孩（67%），她们的胰岛素水平也更高（t = 8.01；p = 0.0003）。患者在青春期不同阶段临床高雄激素血症的发生率增加。癫痫女性患者中发现睾酮和DHEAS水平升高，尤其是青春期和青春期后的女孩。高雄激素血症（临床和/或实验室）受AEDs类型影响最大，服用VPA的患者发生率高于服用酶诱导型AEDs的患者（χ2 = 9.16；p = 0.01）。18%的患者被诊断为多囊卵巢综合征（PCOS）。患有和未患有PCOS的患者在癫痫发作类型、癫痫控制程度、AEDs类型或胰岛素水平方面均未发现差异。
疾病持续时间较长对癫痫女性患者的身高有负面影响。青春期后服用VPA的女孩更容易肥胖，这与高胰岛素血症发生率增加有关。患者中高雄激素血症的临床和/或实验室证据很常见，尤其是使用VPA时。此外，癫痫女性患者，尤其是性成熟的青春期后阶段，PCOS的患病率很高，与AEDs类型或癫痫疾病特征无关。
