Isojärvi J I, Laatikainen T J, Pakarinen A J, Juntunen K T, Myllylä V V
Department of Neurology, University of Oulu, Finland.
N Engl J Med. 1993 Nov 4;329(19):1383-8. doi: 10.1056/NEJM199311043291904.
Reproductive endocrine disorders are more common among women with epilepsy than among normal women. These disorders have been attributed to epilepsy itself, but could be related to antiepileptic-drug therapy.
We studied 238 women with epilepsy who were seen regularly at the Outpatient Department of the University Hospital, Oulu, Finland. Their mean age was 33 years (range, 18 to 45), and the mean duration of therapy was 9 years (range, 0 to 31). Twenty-nine (12 percent) were treated with valproate, 120 (50 percent) with carbamazepine, 12 (5 percent) with valproate and carbamazepine, and 62 (26 percent) with other medications; 15 (6 percent) were untreated. Vaginal ultrasonography was performed to determine ovarian size, and serum sex-hormone concentrations were measured in 41 women with epilepsy and menstrual disturbances, 57 women with epilepsy and regular menstrual cycles, and 51 normal women.
Menstrual disturbances were present in 13 of the women receiving valproate alone (45 percent), 3 of the women receiving valproate in combination with carbamazepine (25 percent), 23 of the women receiving carbamazepine (19 percent), and 8 of those receiving other medications (13 percent). Forty-three percent of the women receiving valproate had polycystic ovaries, and 17 percent had elevated serum testosterone concentrations without polycystic ovaries; 50 percent of the women receiving valproate and carbamazepine had polycystic ovaries, and 38 percent had elevated serum testosterone concentrations without polycystic ovaries. Eighty percent of the women treated with valproate before the age of 20 years had polycystic ovaries of hyperandrogenism.
Menstrual disturbances, polycystic ovaries, and hyperandrogenism are often encountered in women taking valproate for epilepsy.
与正常女性相比，癫痫女性中生殖内分泌紊乱更为常见。这些紊乱一直被归因于癫痫本身，但也可能与抗癫痫药物治疗有关。
我们研究了238名在芬兰奥卢大学医院门诊部定期就诊的癫痫女性。她们的平均年龄为33岁（范围18至45岁），平均治疗时间为9年（范围0至31年）。29名（12%）接受丙戊酸盐治疗，120名（50%）接受卡马西平治疗，12名（5%）接受丙戊酸盐和卡马西平联合治疗，62名（26%）接受其他药物治疗；15名（6%）未接受治疗。进行阴道超声检查以确定卵巢大小，并对41名有癫痫和月经紊乱的女性、57名有癫痫且月经周期规律的女性以及51名正常女性测量血清性激素浓度。
单独接受丙戊酸盐治疗的女性中有13名（45%）出现月经紊乱，接受丙戊酸盐与卡马西平联合治疗的女性中有3名（25%）出现月经紊乱，接受卡马西平治疗的女性中有23名（19%）出现月经紊乱，接受其他药物治疗的女性中有8名（13%）出现月经紊乱。接受丙戊酸盐治疗的女性中有43%患有多囊卵巢，17%的女性血清睾酮浓度升高但无多囊卵巢；接受丙戊酸盐和卡马西平联合治疗的女性中有50%患有多囊卵巢，38%的女性血清睾酮浓度升高但无多囊卵巢。20岁之前接受丙戊酸盐治疗的女性中有80%患有多囊卵巢或高雄激素血症。
服用丙戊酸盐治疗癫痫的女性常出现月经紊乱、多囊卵巢和高雄激素血症。
