Many Epileptic Women Face Sexual Issues
Seizure locus also seems to be related to the type of sexual dysfunction a woman may experience, Dr. Herzog said. In 2003, he examined this relationship in 36 women with right or left temporal lobe epilepsy and 12 controls. All of the women completed the Arizona Sexual Experience Scale (ASEX). They also received continuous EEG recordings for 8 hours, during which 5-cc blood samples were drawn every 10 minutes.
The ASEX scores were significantly higher (worse) in women with epilepsy than in controls; women with right temporal lobe epilepsy (RTLE) had higher scores than did those with left TLE.
A significant number of women with epilepsy also had subnormal gonadal steroid levels. Women with RTLE tended to have low levels of bioactive testosterone, whereas those with LTLE were more likely to have low estradiol.
The association of sexual dysfunction and laterality of seizure locus supports a biologic brain-based mechanism, Dr. Herzog wrote. “There is increasing evidence to support the existence of lateralized brain asymmetries in the regulation of neuroendocrine, reproductive, and sexual functions” in animal studies. For instance, he noted, female rat brains contain up to 100% more gonadotropin-releasing hormone content in the right side of the hypothalamus than in the left.
The finding of more sexual dysfunction with RTLE may reflect a similar lateralized asymmetry in areas of the human hypothalamus that influence sexual function, he wrote, especially because unilateral epileptiform discharges tend to affect the hypothalamus ipsilaterally.
The understanding of epilepsy's influence on hormones and sexuality is still in its infancy, Dr. Mushtaq said. “As research continues to unfold, we are likely to discover that this is also the factor behind the fertility problems women with epilepsy can experience.”
In the meantime, clinicians should be vigilant about screening these women for sexual difficulties, and referring them to specialists. “When do [neurologists] ever ask patients about their sex life, or about their premenstrual emotional problems?” she said. “It's a topic that has been almost taboo.”
