Psychoneuroendocrine aspects of temporolimbic epilepsy - Part I. Brain, reproductive steroids, and emotions

The temporolimbic structures of the brain that subserve emotional represent ation are highly epileptogenic and play an important role in the modulation of hormonal secretion and mediation of hormonal feedback. Estrogen is high ly epileptogenic and exerts energizing and antidepressant effects. Excessiv e estrogen influence produces anxiety, agitation, irritability, and labilit y. It can promote the development of anxiety manifestations (e.g., panic, p hobias, and obsessive-compulsive disorder). Progesterone and its metabolite s inhibit kindling and seizure activity. They have potent anxiolytic effect s, possibly by virtue of their GABAergic activity. Excessive progesterone i nfluence produces sedation and depression. Testosterone has two major metab olites: estradiol, which can exacerbate seizures, and dihydrotestosterone, which blocks NMDA-type glutamate transmission and may be responsible for an tiseizure effects. Testosterone has energizing effects and increases sexual desire in both men and women. In excess, however it may promote aggressive , impulsive, and hypersexual behavior Hormonal effects tend to be exaggerat ed or idiosyncratic in the setting of an abnormal or anomalous temporolimbi c substrate, especially temporolimbic epilepsy. This may reflect altered ne uronal responsivity to hormonal exposure perhaps by virtue of changes in th e number of dendritic spines and receptors.