Department of Pediatrics, University of Chieti, Via dei Vestini 5, 66100 Chieti, Italy.
Expert Rev Neurother. 2009 Dec;9(12):1803-14. doi: 10.1586/ern.09.112.
Women with epilepsy have a higher incidence of reproductive endocrine disorders than the general female population. These alterations include polycystic ovary syndrome, hyperandrogenemia, infertility, hypothalamic amenorrhea and hyperprolactinemia. Reproductive dysfunction is attributed both to epilepsy itself and to antiepileptic drugs (AEDs). Focal epileptic discharges from the temporal lobe may have a direct influence on the function of the hypothalamic-pituitary axis, thus altering the release of sex steroid hormones, including the production of luteinizing hormone, follicle-stimulating hormone, gonadotropin-releasing hormone and prolactin. AEDs may modulate hormone release from the hypothalamic-pituitary-gonadal axis and they may alter the metabolism of sex hormones and their binding proteins. Hepatic enzyme-inducing AEDs, such as carbamazepine and phenytoin, may be most clearly linked to altered metabolism of sex steroid hormones, but valproic acid, an enzyme inhibitor, has also been associated with a frequent occurrence of polycystic ovary syndrome and hyperandrogenism in women with epilepsy. Therefore, treatment of epilepsy and selection of AEDs are important for reproductive health in female patients. The aim of the present review is to critically evaluate the recently published data concerning the interactions between sex hormones, epilepsy and AEDs.
患有癫痫的女性比一般女性人群更容易发生生殖内分泌紊乱。这些改变包括多囊卵巢综合征、高雄激素血症、不孕、下丘脑性闭经和高催乳素血症。生殖功能障碍既归因于癫痫本身，也归因于抗癫痫药物（AEDs）。来自颞叶的局灶性癫痫放电可能直接影响下丘脑-垂体轴的功能，从而改变包括黄体生成素、卵泡刺激素、促性腺激素释放激素和催乳素在内的性激素的释放。AEDs 可能调节下丘脑-垂体-性腺轴的激素释放，并且可能改变性激素及其结合蛋白的代谢。肝酶诱导型 AED，如卡马西平和苯妥英钠，可能与性激素代谢改变最相关，但酶抑制剂丙戊酸也与癫痫女性中多囊卵巢综合征和高雄激素血症的频繁发生相关。因此，治疗癫痫和选择 AED 对女性患者的生殖健康很重要。本综述的目的是批判性地评估最近发表的关于性激素、癫痫和 AED 之间相互作用的相关数据。
