[The role of the antiepileptic drugs at the development of the sexual dysfunctions in male epileptic patients].

It is well known that alterations in sexual functions occur more frequently in men with epilepsy than in general population. The results of the epidemiological studies are considerably diverge from one another (3-61%), so the exact value of the incidence is not known. The most common form of sexual dysfunctions is the hyposexuality, determined as a overall reduction in sexual interest, awareness, and activity. Sexual dysfunction, as a disorder is often multifactorial, but the role of medical factors can be the most important in the development. The endocrinological disturbances occurring in epilepsy are mainly caused by the pharmacokinetic interactions among the antiepileptic medication. The enzyme inductor drugs decrease the level of free testosterone, dihydrotestosterone, follicle stimulating hormone, and luteinizing hormone, and increase the sex-hormone-binding globulin and estradiol levels. In valproate treated men significantly lower follicle stimulating hormone and luteinizing hormone concentrations, and free/total carnitine ratio, and higher dehydroepiandrosterone concentration can be detected. The enzyme inductor antiepileptic drugs can decrease the biologically active testosterone level by stimulating the aromatase and the hepatic cytochrome P450 enzymes, which can result in the development of sexual dysfunctions. Hormonal changes resulting in the alteration of the androgen synthesis and gonadotropin levels may contribute to the sexual dysfunction observed in valproate treated epileptic patients. If the role of the antiepileptic medication can be proven in the development of the sexual dysfunctions, changing in the antiepileptic drug therapy is recommended. According to evidences, the usage of oxcarbazepine and lamotrigine is not associated with changes in hormonal levels, and does not lead to alterations in sexual functions. In case of sexual dysfunctions switching from carbamazepine to oxcarbazepine, levetiracetam, or gabapentin is recommended in patients with partial epilepsy, and from valproate to lamotrigine or levetiracetam in patients with idiopathic generalized epilepsy. Enforcement of the primary prevention in the treatment of men with epilepsy is an important task of the future.