Hamed Sherifa A, Hermann Bruce P, Moussa Ehab M M, Youssef Ahmad H, Rageh Tarek A, Elserogy Yaser E, NasrEldin Eman
Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
Department of Neurology, University of Wisconsin, USA.
Seizure. 2015 Feb;25:40-8. doi: 10.1016/j.seizure.2014.12.002. Epub 2014 Dec 12.
Erectile dysfunction (ED) is common in males with epilepsy, likely of multifactorial etiology, including possible systemic vascular comorbidities and medication effects. Here we examined male patients for the possibility of a vasculogenic element of ED.
Research participants included 47 men with epilepsy (mean age=30.98 years; duration of illness=13.98 years) and 25 healthy matched men (mean age=30.36). Erectile function was assessed using the International Index of Erectile Function Questionnaire (IIEF-5). Penile blood flow was assessed using Duplex Ultrasonography (PDU) after intracavernous alprostadil injection. Penile peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were the functional parameters analyzed. Carotid artery intima media thickness (CA-IMT) was also measured.
Thirteen of the 47 men with epilepsy (23.40% versus 0% for controls) reported ED, and of these patients, 11 (84.62%) had abnormal PDU [PSV=28.23 ± 6.1cm/s, P=0.0001; EDV=2.22 ± 5.71 cm/s, P=0.004; RI=0.89 ± 0.22, P=0.071] suggesting vasculogic ED. Penile arterial insufficiency was identified in 5 (45.45%), while 6 (54.54%) had mixed arterial insufficiency and venous leak. Compared to patients with high PSV, patients with low PSV had lower IIED-5 scores, higher EDV, lower RI, higher diastolic blood pressure and higher CA-IMT values. There were no differences in depression, anxiety or concentrations of sex hormones. Significant correlations were evident between PDU variables and duration of illness, depression and anxiety scores and CA-IMT values. In multivariate analysis, the association between PDU parameters and CA-IMT values remained significant even after adjustment for other confounding variables.
Vasculogenic ED is frequent with epilepsy and its relationship to systemic atherosclerosis cannot be excluded.
勃起功能障碍（ED）在癫痫男性患者中很常见，其病因可能是多因素的，包括可能存在的全身性血管合并症和药物影响。在此，我们研究了男性患者中ED的血管源性因素的可能性。
研究参与者包括47名癫痫男性患者（平均年龄=30.98岁；病程=13.98年）和25名健康对照男性（平均年龄=30.36岁）。使用国际勃起功能指数问卷（IIEF-5）评估勃起功能。在海绵体内注射前列地尔后，使用双功超声（PDU）评估阴茎血流。分析阴茎峰值收缩速度（PSV）、舒张末期速度（EDV）和阻力指数（RI）等功能参数。还测量了颈动脉内膜中层厚度（CA-IMT）。
47名癫痫男性患者中有13名（23.40%，而对照组为0%）报告有ED，在这些患者中，11名（84.62%）的PDU异常[PSV=28.23±6.1cm/s，P=0.0001；EDV=2.22±5.71cm/s，P=0.004；RI=0.89±0.22，P=0.071]，提示血管性ED。5名（45.45%）患者存在阴茎动脉供血不足，而6名（54.54%）患者既有动脉供血不足又有静脉漏。与PSV高的患者相比，PSV低的患者IIED-5评分更低、EDV更高、RI更低、舒张压更高且CA-IMT值更高。在抑郁、焦虑或性激素浓度方面没有差异。PDU变量与病程、抑郁和焦虑评分以及CA-IMT值之间存在显著相关性。在多变量分析中，即使在调整其他混杂变量后，PDU参数与CA-IMT值之间的关联仍然显著。
血管性ED在癫痫患者中很常见，且不能排除其与全身性动脉粥样硬化的关系。
