Sexual Dysfunction in Women with Epilepsy and their Causes

Česká verzia

Authors: V. Zelená; R. Kuba
Authors place of work: I. neurologická klinika LF MU a FN u sv. Anny v Brně
Published in the journal: Cesk Slov Neurol N 2008; 71/104(3): 271-276
Category: Review Article

Summary

Sexual dysfunction is a relatively common comorbidity in women with epilepsy which may significantly influence the quality of patients’ life. In the literature its prevalence varies from 15 to 85%, which probably reflects methodical problems linked to its assessment. Sexual dysfunction used to be considered merely a decrease in libido or arousal. Currently several subtypes of women’s sexual dysfunction are distinguished. The cause of sexual dysfunction in women with epilepsy is probably multifactorial. The factors likely responsible are epilepsy itself, psychosocial factors and antiepileptic medication. Epileptic discharges may affect function of limbic structures responsible for normal sexual responsiveness. Improvement of sexual function occurs with better compensation of epilepsy attained either by epilepsy surgery or by medication while complete remission of seizures is the key issue. Both epilepsy and liver enzyme inducing antiepileptic drugs may induce endocrine changes that may be partly in cause loss of libido and arousal. This applies in case of lower androgen and oestrogen blood levels and high prolactin levels. Limbic functions may obviously be altered by the direct effect of antiepileptic medication. More research is needed to clarify this and also the relation of psychosocial factors to sexual dysfunction. So far a positive correlation between depression and dyspareunia was suggested in the case of women with epilepsy.

Key words:
sexual dysfunction – epilepsy – women – antiepileptics

Zdroje

1. Pietropinto A, Arora A. Epilepsy and sexual functionning – survey analysis. Med Aspects Human Sex 1988; 22: 140–144.

2. Ndgegwa D, Rust J, Golombok S, Fenwick P. Sexual problems in epileptic women. J Sex Marital Ther 1986; 1(2): 175–177.

3. Toone BK. Sexual disorders in epilepsy. In: Pedley TA, Meldrum BS (eds). Recent advances in epilepsy. 3rd ed. Edinburgh: Churchill Livingstone 1986: 233–259.

4. Drislane FW, Coleman AE, Schomer DL, Ives J, Levesque LA, Seidel MM et al. Altered pulzatile sexretion of luteinizing hormone in women with epilepsy. Neurology 1994; 44(2): 306–310.

5. Herzog AG. A relationship between particular reproductive endocrine disorders and the laterality of epileptiform discharges in women with epilepsy. Neurology 1993; 43(10): 1907–1910.

6. Herzog AG, Coleman AE, Jacobs AR, Klein P, Friedman MN, Drislane FW et al. Relationship of sexual dysfunction to epilepsy laterality and reproductive hormone levels in women. Epilepsy Behav 2003; 4(4): 407–413.

7. Sakuma Y. Brain control of female sexual behavior. In: Jokohama A (ed). Brain control of the reproductive system. Tokyo: Japan Scientific Societies 1992: 141–155.

8. Herzog AG. Intermitent progesterone therapy and frequency of complex partial seizures in women with menstrual disorders. Neurology 1986; 36(12): 1607–1610.

9. Toone BK. Epilepsy and sexual life. In: Hopkins A, Shorvon S, Cascino G (eds). Epilepsy. 2nd Ed. London: Chapman and Hall 1995: 277–287.

10. Spark RF, Wills CA, Royal H. Hypogonadism, hyperprolactinemia and temporal lobe epilepsy in hyposexual men. Lancet 1984; 1(8374): 413–417.

11. Meierkord H, Shorvon S, Lightman S, Trimble M. Comparison of the effects of frontal and temporal lobe partial seizures on prolactin levels. Arch Neurol 1992; 49(3): 225–230.

12. Daniele A, Azzoni A, Bizzi A, Rossi A, Gainotti G, Mazza S. Sexual behavior and hemispheric laterality of the focus in patients with temporal lobe epilepsy. Biol Psychiatry 1997; 42(7): 617–624.

13. Levesque LA, Herzog AG, Seibel MM. The effect of phenytoin and carbamazepine on serum dehydroepiandrosterone sulfate in men and women who have partial seizures with temporal lobe involvement. J Clin Endocrinol Metab 1986; 63(1): 243–245.

14. Stoffel-Wagner B, Bauer J, Flugel D, Brennemann W, Klingmuller D, Elger CE. Serum sex hormones are altered in patiens with chronic temporal lobe epilepsy receiving anticonvulsant medication. Epilepsia 1998; 39(11): 1164–173.

15. Coulam CB, Annegers JF. Do anticonvulsants reduce the efficacy of oral contraceptives? Epilepsia 1979; 20(5): 519–525.

16. Lewin W, Kuntzman R, Conney AH. Stimulatory effect of phenobarbital on the metabolism of the oral contraceptive 17 alpha- ethynylestradiol-3-methyl ether (mestranol) by rat liver microsomes. Pharmacology 1979; 19(5): 249–255.

17. Spark RF. Dehydroepiandrosterone: a springboard hormone for female sexuality. Fertil Steril 2002; 77(Suppl 4): S19–S25.

18. Panjari M, Davis SR. DHEA therapy for women: effect on sexual function and wellbeing. Hum Reprod Update 2007; 13(3): 239–248.

19. Davis SR, Davison SL, Donath S, Bell RJ. Circulating Androgen Levels and Self-reported Sexual Function in Women. JAMA 2005; 294(1): 91–96.

20. Morrell MJ, Flynn KL, Seale GC, Done S, Paulson AJ, Flaster ER et al. Reproductive dysfunction in women with epilepsy: antiepileptic drug effects on sex-steroid hormones. CNS Spectr 2001; 6(9): 771–786.

21. Morrell MJ, Flynn KL, Done S, Flaster E, Kalayian L, Pack AM. Sexual dysfunction, sex steroid hormone abnormalities, and depression in women with epilepsy treated with antiepileptic drugs. Epilepsy Behav 2005; 6(3): 360–365.

22. Morrell MJ. Reproductive and metabolic disorders in women with epilepsy. Epilepsia 2003; 44(Suppl 4): 11–20.

23. Morrell MJ, Giudice L, Flynn KL, Seale CG, Paulson AJ, Done S et al. Predictors of ovulatory failure in women with epilepsy. Ann Neurol. 2002; 52(6): 704–711.

24. Herzog AG, Schachter SC. Valproate and the polycystic ovarian syndrome: final thoughts. Epilepsia 2001; 42(3): 311–315.

25. Gil-Nagel A, Lopez-Munoz F, Serratosa JM, Moncada I, Garcia-Garcia P, Álamo C. Effect of lamotrigine on sexual function in patients with epilepsy. Seizure 2006; 15(3): 142–149.

26. Bialer M. The pharmacokinetics and interactions of new antiepileptic drugs: an overview. Ther Drug Monit 2005; 27(6): 722–726.

27. Patsalos PN. Phramacokinetic profile of levetiracetam: toward ideal chracteristics. Pharmacol Ther 2000; 85(2): 77–85.

28. Drabkin R, Calhoun L. Anorgasmia and withdrawal syndrome in a woman taking gabapentin. Can J Psychiatry 2003; 48(2): 125–126.

29. Mtchedlishvili Z, Bertram E, Kapur J. Diminished allopregnanolone enhancement of GABA(A) receptor currents in a rat model of chronic temporal lobe epilepsy. J Physiol 2001; 537(Pt 2): 453–465.

30. Gastaut H, Collomb H. Etude du comportement sexual chez les épileptiques psychomotors. Ann Med Psychol 1954; 112: 657–696.

31. Ferney DM, Gullotta FP, Gilmore W. Hyposexuality produced by temporal lobe epilepsy in the cat. Epilepsia 1998; 39(2): 140–149.

32. Herzog AG. Endocrine aspects of epilepsy in women. In: Pedley TA, Meldrum BS (eds). Recent Advances in Epilepsy. 6th ed. Edinburgh, Churchill Livingstone 1995: 221–237.

33. Heath RG. Pleasure and brain activity in man. Deep and surface electroencephalograms during orgasm. J Nerv Ment Dis 1972; 154(1): 3–18.

34. Bergen D, Daugherty S, Eckenfels E. Reduction of sexual activities in females taking antiepileptic drugs. Psychopatology 1992; 25(1): 1–4.

35. Morrell MJ, Guldner GT. Self-reported sexual function and sexual arousability in women ith epilepsy. Epilepsia 1996; 37(12): 1204–1210.

36. Demerdash A, Shaalan M, Midani A, Kamel F, Bahri M. Sexual behavior of a sample of females with epilepsy. Epilepsia 1991; 32(1): 82–85.

37. Taylor DC. Sexual behaviour and temporal lobe epilepsy. Arch Neurol 1969; 21(5): 510–516.

38. Shukla GD, Sirvastava OM, Katiyar BC. Sexual disturbances in temporal lobe epilepsy: a controlled study. Br J Psychiatry 1979; 134: 288–292.

39. Murialdo G, Galimberti CA, Fonzi S, Manni R, Costelli P, Parodi C et al. Sex hormones and pituitary function in male epileptic patients with altered or normal sexuality. Epilepsia 1995; 36(4): 360–365.

40. Jensen P, Jensen SB, Sorensen PS, Bjerre BD, Rizzi DA, Sørensen AS et al. Sexual dysfunction in male and female patients with epilepsy: a study of 86 outpatients. Arch Sex Behav 1990; 19(1): 1–14.

41. Duncan S, Blacklaw J, Beastall GH, Brodie MJ. Sexual function in women with epilepsy. Epilepsia 1997; 38(10): 1074–1081.

42. Walker AE, Blumer D. Long term effects of temporal lobe lesions on sexual behaviour and aggressivity. In: Fields WS, Sweet WH (eds). Neural Bases of Violence and Aggression. St.Louis. USA: W.H. Green Inc 1975: 392–400.

43. Hierons R, Saunders R. Impotence in patients with temporal lobe lesions. Lancet 1966; 2(7467): 761–763.

44. Artilles Perez V, Gutierrez Sigler, Sanfelix Genoves J. Female sexual functionning and related factors. Aten Primaria 2006; 38: 339–344.

45. Morrell MJ, Sperling MR, Stecker M, Dichter MA. Sexual dysfunction in partial epilepsy: a deficit in physiologic sexual arousal. Neurology 1994; 44(2): 243–247.