Reproductive disturbances in patients with epilepsy
Martha J. Morrell, MD
College of Physicians and Surgeons, Columbia University, and the Columbia Comprehensive Epilepsy Center, New York–Presbyterian Health System, New York, NY
Georgia D. Montouris, MD
Boston University School of Medicine and the Epilepsy Center of Boston University Medical Center, Boston, MA
Correspondence: Martha J. Morrell, MD, Department of Neurology, The Neurological Institute, 710W. 168th Street, New York, NY 10032
Dr. Morrell receives research support from Novartis, Abbott, the National Institutes of Health, and GlaxoSmithKline; is a consultant for Novartis, Abbott, GlaxoSmithKline, Ortho-McNeil, Elan, and Schwarz Pharma; and has received honoraria from Novartis, Abbott, Pfizer, GlaxoSmithKline, Ortho-McNeil, and Elan.
Dr. Montouris receives grants/research support from Schwarz Pharma and UCB Pharma; is a consultant for Pfizer, GlaxoSmithKline, Abbott, Ortho-McNeil, and Elan; is a stock shareholder (not major) in Johnson & Johnson and Merck; and has received honoraria from Abbott, Cyberonics, Elan, GlaxoSmithKline, Novartis, Ortho-McNeil, UCB Pharma, Shire, Xcel Pharmaceuticals, and Pfizer.
In persons with epilepsy, both seizures and antiepileptic drugs can disturb reproductive health. For example, seizures can alter the release of hypothalamic and pituitary hormones, while some antiepileptic drugs alter concentrations of sex steroid hormones. Women with epilepsy are at increased risk for polycystic ovary syndrome and disorders of the menstrual cycle. Studies have found reduced fertility rates among men and women with epilepsy. The reasons for this reduction in fertility are likely to be both psychosocial and physiologic, and again, both epilepsy itself and antiepileptic drugs are implicated. Sexual dysfunction is common among patients with epilepsy and can have a somatic, psychological, or social basis. To provide the best care for patients with epilepsy, particularly women of reproductive age, clinicians must consider both the gender-based biology of epilepsy and the effects of antiepileptic drugs on reproductive health.