Neuroendocrine considerations in the treatment of men and women with epilepsy

• Published in: Lancet neurology Vol. 12; no. 1; pp. 72 - 83
• Main Authors: Harden, Cynthia L, Prof, Pennell, Page B, MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 2013
• Subjects: Anticonvulsants - adverse effects; Anticonvulsants - metabolism; Anticonvulsants - therapeutic use; Antiepileptic agents; Brain; Brain - drug effects; Brain - metabolism; Brain - physiopathology; Epilepsy; Epilepsy - drug therapy; Epilepsy - metabolism; Epilepsy - physiopathology; Excitability; Female; Hormones; Humans; Hypothalamus; Male; Neurology; Neurosteroids; Neurotransmitter Agents - adverse effects; Neurotransmitter Agents - metabolism; Neurotransmitter Agents - therapeutic use; Pharmacokinetics; Reproduction - drug effects; Reproduction - physiology; Seizures; Treatment Outcome
• ISSN: 1474-4422; 1474-4465
• DOI: 10.1016/S1474-4422(12)70239-9

Summary Complex, multidirectional interactions between hormones, seizures, and the medications used to control them can present a challenge for clinicians treating patients with epilepsy. Many hormones act as neurosteroids, modulating brain excitability via direct binding sites. Thus, changes in endogenous or exogenous hormone levels can affect the occurrence of seizures directly as well as indirectly through pharmacokinetic effects that alter the concentrations of antiepileptic drugs. The underlying structural and physiological brain abnormalities of epilepsy and the metabolic activity of antiepileptic drugs can adversely affect hypothalamic and gonadal functioning. Knowledge of these complex interactions has increased and can now be incorporated in meaningful treatment approaches for men and women with epilepsy.