REDUCED FERTILITY AND NEUROENDOCRINE DYSFUNCTION IN WOMEN WITH EPILEPSY

A reduction of fertility in women with epilepsy has been reported sinc e 1950 and is confirmed in recent epidemiological studies. This phenom enon has usually been attributed to the increase of medical and socioe conomic problems in these patients or to hyposexuality, which has been consistently observed in epileptic subjects. Recently, a higher occur rence of reproductive endocrine diseases has been reported in epilepti c women and proposed as an important cause of reduced fertility. In pa rticular, polycystic ovary syndrome and hypothalamic ovarian failure h ave been reported in epileptic women with increased frequency compared to the general population. Moreover, an abnormal pattern of luteinizi ng hormone (LH) pulsatility has been observed in normally cycling, dru g-free epileptic women. We suggest that epilepsy may interfere with th e functional activity of the gonadotropin releasing hormone (GnRH) pul se generator. It is possible that paroxysmal discharges spreading with in the hypothalamus might affect the regularity of the GnRH pulse gene rator; alternatively, a neurotransmitter dysfunction might at the same time be responsible both for the lowering of the seizure threshold an d for the dysfunction of GnRH secretion. The consequent alteration of LH pulsatility might in the long run, under the effect of additional f actors, give rise to a clinical reproductive endocrine disorder.