Epilepsy Talk

Hormones and Epilepsy in Women and Men… | January 28, 2021

There’s a dynamic relationship between hormones, brain function, and seizures.

Whether you’re a woman or a man, sex hormones can influence the excitability of nerve cells in the brain and thus influence seizure control.

Hormones generally don’t cause seizures but can influence if or when they happen.

The brain is the seat of the body’s hormones and regulates the release of the major sex hormones — estrogen, progesterone, and testosterone.

These hormones, in turn, provide feedback to the brain and control the amount of hormones released at different points in time.

The interactions between hormones, epilepsy, and the medications used to treat epilepsy are complex, with interactions which affect both men and women in various ways.

Abnormalities of baseline endocrine status occur more commonly in people with epilepsy.

Research has shown that seizure discharges in certain brain areas can alter the output of hormones from the brain, and sex hormones can influence how the brain works.

For example, estrogen has been shown to increase seizure activity, while progesterone can have anti-seizure effects.

Seizures that are most likely to be affected by hormonal changes are partial seizures that involve the temporal or frontal lobes of the brain. 

However, hormonal associations may also be seen with generalized seizures.

The temporal and frontal areas of the brain are closely connected to the hypothalamus and pituitary glands of the brain, which control the release of hormones.

Women

Some women with epilepsy experience changes in their seizure patterns at times of hormonal fluctuations.

For example, puberty is a time when hormones are stimulating body changes. It is not unusual for certain kinds of seizures to disappear at puberty, while other seizure disorders may start at this time.

Many women with epilepsy see changes in the number or the pattern of their seizures around the time of ovulation (mid-cycle), or just before and at the beginning of their menstrual periods, which is known as “Catamenial Epilepsy”.

Research shows that the female hormones, estrogen and progesterone, act on certain brain cells, including those in the temporal lobe, a part of the brain where partial seizures often begin.

Estrogen excites these brain cells and can make seizures more likely to happen.

In contrast, natural progesterone can inhibit or prevent seizures in some women.

Findings also indicate that women who have seizures that start in the temporal lobes of the brain seem more likely to have reproductive disorders such as sexual dysfunction, decreased fertility, premature menopause, polycystic ovarian syndrome, and irregular (or no) ovulation, than women in the general population.

Men

Hormonal changes in men are less obvious than in women because men do not have a monthly cycle.

In the case of men, experts estimate that approximately 40 percent of men with epilepsy have low levels of testosterone, the hormone that stimulates the development of male sex organs, sexual traits and sperm.

Some of the older seizure medications lower the active part of testosterone.

Both epilepsy itself and the antiepileptic drugs (AEDs) used to control seizures may be responsible for these hormonal changes.

Persistent seizures in adults may be associated with hormonal and neurological changes that contribute to sexual dysfunction.

Temporal lobe epilepsy, in particular, is known to have adverse effects on testicular endocrine function.

Research suggests that the AEDs phenytoin, carbamazepine and phenobarbital adversely affect hormone levels by reducing the level of free testosterone which, in turn, reduces sexual desire.

Some good news regarding AEDs and hormonal effects does exist: Studies show that the AED lamotrigine may not have a negative impact on sexual function.

In fact, in one study, lamotrigine was shown to have a favorable effect on sexual disorders in men with epilepsy who had partial seizures and were taking other AEDs.

Reduced testosterone, one hormonal effect frequently seen in men with epilepsy, can adversely affect one or more of the following: energy, mood, drive, sexual function, bone density and seizure control.

Both

Estrogen can excite brain cells and can make seizures more likely to happen. In contrast, natural progesterone breaks down into a substance that can inhibit or prevent seizures in some women.

Epilepsy and antiepileptic drugs can alter sex hormone levels to promote the development of reproductive endocrine disorders in both women and men.

Treatment of epilepsy and selection of antiepileptic drugs may be important to reproductive health in women and men with epilepsy. Sex steroids and their metabolites may also provide treatment for seizures.

It’s important to keep track of other factors that may affect seizure patterns, such as missed medication, loss of sleep, unusual fatigue, intense physical training, stress or an illness.

If you suspect that hormones play a role in your seizures, talk to your physician or the nurse who helps monitor your seizures. Blood tests of certain hormone levels and of your seizure medication may provide helpful information.

Those who have special concerns about seizures and hormones should obtain a referral to a specialist, either a neurologist or a neuroendocrinologist (a neurologist with training in hormone disorders and their effects on brain function).

 

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Resources:

http://www.epilepsy.com/information/women/all-women/hormones-and-epilepsy

http://www.pathophys.org/sexhormones/

http://www.efepa.org/living-with-epilepsy/men-with-epilepsy/#ME1

http://journals.lww.com/co-neurology/Abstract/2005/04000/Sexual_hormones_and_epilepsy__threat_and.15.aspx

http://www.epilepsygroup.com/epilepsy-information-sub-detail5-59-18-78/epilepsy-seizure-men-health.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424285/

 

 

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