Psychoneuroendocrine aspects of temporolimbic epilepsy - Part II: Epilepsyand reproductive steroids

Reproductive dysfunction is unusually common among men and women with epile psy Reproductive endocrine disorders are also common and may be causal. The association between parlicular reproductive endocrine disorders and the la terality and focality of epileptiform discharges suggests an etiologic role for epilepsy Gonadal steroids are neuroactive and influence seizure occurr ence: estrogen is epileptogenic whereas progesterone has antiseizure Effect s. Fluctuations in the absolute and relative serum levels of these hormones may play a critical role in establishing three distinct patterns of catame nial epilepsy: I) perimenstrual and 2) preovulatory in women with ovulatory cycles, and 3) entire luteal phase of the cycle in women with anovulatory cycles. Treatment with progesterone reduces seizure frequency by more than half In men, testosterone effects may depend an the relative concentrations of two major testosterone metabolites that evert opposing influences on ne uronal excitability: estrogen potentiates whereas dihydrotestosterone inhib its NMDA-mediated conductance. Combined therapy using an acromatase inhibit or along with testosterone improves sexual function and may reduce seizures in men with epilepsy.