Carosella Christopher M, Johnson Emily L
Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland.
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland.
Semin Neurol. 2025 Apr;45(2):198-205. doi: 10.1055/a-2551-0688. Epub 2025 Apr 3.
The relationship between sex hormones and epilepsy involves intricate interactions that influence seizure susceptibility, reproductive health, and treatment approaches. Estrogen generally exhibits proconvulsant effects, while progesterone and its metabolite allopregnanolone have anticonvulsant properties. Variability in hormone levels during the menstrual cycle can exacerbate seizures, a phenomenon known as catamenial epilepsy. Effective management often requires a tailored combination of antiseizure medications (ASMs) and hormonal therapies. Women and others of childbearing potential face unique challenges, including higher rates of menstrual dysfunction, potential exacerbation of seizures during pregnancy, and increased risks associated with hormonal contraception and menopause. Careful ASM selection is critical to ensure maternal and fetal safety, with lamotrigine, levetiracetam, and oxcarbazepine being preferred options. Postpartum ASM adjustments and breastfeeding considerations are also essential for optimizing outcomes. Emerging research highlights the impact of hormonal interactions in transgender individuals undergoing gender-affirming therapies. For transwomen, estrogen could heighten seizure risk. Close monitoring and collaboration between health care providers are crucial for personalized care. The complex interplay between hormones and epilepsy underscores the need for ongoing research and individualized approaches to optimize seizure control and address the unique reproductive health needs of people with epilepsy.
性激素与癫痫之间的关系涉及复杂的相互作用，这些相互作用会影响癫痫易感性、生殖健康和治疗方法。雌激素通常具有促惊厥作用，而孕激素及其代谢物别孕烯醇酮则具有抗惊厥特性。月经周期中激素水平的变化会加重癫痫发作，这一现象被称为经期癫痫。有效的管理通常需要抗癫痫药物（ASMs）和激素疗法的定制组合。有生育潜力的女性及其他人群面临着独特的挑战，包括月经功能障碍发生率较高、怀孕期间癫痫发作可能加重，以及激素避孕和更年期相关风险增加。谨慎选择抗癫痫药物对于确保母婴安全至关重要，拉莫三嗪、左乙拉西坦和奥卡西平是首选药物。产后调整抗癫痫药物以及考虑母乳喂养对于优化治疗效果也至关重要。新兴研究突出了激素相互作用对接受性别确认疗法的跨性别者的影响。对于跨性别女性而言，雌激素可能会增加癫痫发作风险。医疗保健提供者之间的密切监测与合作对于个性化护理至关重要。激素与癫痫之间复杂的相互作用凸显了持续研究和个性化方法的必要性，以优化癫痫控制并满足癫痫患者独特的生殖健康需求。
