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Guo J, Liu Y, Kong L, Sun Y, Lu Z, Lu T, Qu H, Yue W. Comparison of the probability of four anticonvulsant mood stabilizers to facilitate polycystic ovary syndrome in women with epilepsies or bipolar disorder-A systematic review and meta-analysis. Front Psychiatry 2023; 14:1128011. [PMID: 37229383 PMCID: PMC10203219 DOI: 10.3389/fpsyt.2023.1128011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Background Patients treated with anticonvulsant mood stabilizers have a higher incidence of polycystic ovary syndrome (PCOS). However, there is no comparison between different anticonvulsant mood stabilizers. The purpose of this study was to systematically evaluate the prevalence of PCOS in women taking anticonvulsant mood stabilizers and compare the probability of PCOS caused by different anticonvulsant mood stabilizers. Methods Five databases, namely PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials, were searched for literature on anticonvulsant mood stabilizers and PCOS published up to October 28, 2022. This meta-analysis was performed using Revman 5.4, Stata 14.0, and R4.1.0, and effect size pooling was performed in fixed- or random-effects models based on the results of I2 and Q-test, and the surface under the cumulative ranking curve (SUCRA) was used for analysis to assess the cumulative probability of drug-induced PCOS. Publication bias was assessed by funnel plot Egger's test and meta regression. Results Twenty studies with a total of 1,524 patients were included in a single-arm analysis, which showed a combined effect size (95% CI) of 0.21 (0.15-0.28) for PCOS in patients taking anticonvulsant mood stabilizers. Nine controlled studies, including 500 patients taking medication and 457 healthy controls, were included in a meta-analysis, which showed OR = 3.23 and 95% CI = 2.19-4.76 for PCOS in women taking anticonvulsant mood stabilizers. Sixteen studies with a total of 1416 patients were included in a network meta-analysis involving four drugs, valproate (VPA), carbamazepine (CBZ), oxcarbazepine (OXC), and lamotrigine (LTG), and the results of the network meta-analysis showed that VPA (OR = 6.86, 95% CI = 2.92-24.07), CBZ (OR = 3.28, 95% CI = 0.99-12.64), OXC (OR = 4.30, 95% CI = 0.40-49.49), and LTG (OR = 1.99, 95% CI = 0.16-10.30), with cumulative probabilities ranked as VPA (90.1%), OXC (63.9%), CBZ (50.1%), and LTG (44.0%). Conclusion The incidence of PCOS was higher in female patients treated with anticonvulsant mood stabilizers than in the healthy population, with VPA having the highest likelihood of causing PCOS. The most recommended medication when considering PCOS factors is LTG. Systematic review registration identifier: CRD42022380927.
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Affiliation(s)
- Jing Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, China
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, China
| | - Yan Liu
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, China
| | - Lingling Kong
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, China
| | - Yaoyao Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Zhe Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Tianlan Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Haiying Qu
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, China
| | - Weihua Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, China
- Department of Psychology, Medical Humanities Research Center, Binzhou Medical University, Yantai, China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
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Lai W, Shen N, Zhu H, He S, Yang X, Lai Q, Li R, Ji S, Chen L. Identifying risk factors for polycystic ovary syndrome in women with epilepsy: A comprehensive analysis of 248 patients. J Neuroendocrinol 2023; 35:e13250. [PMID: 36942563 DOI: 10.1111/jne.13250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/04/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
To assess the risk factors for polycystic ovary syndrome (PCOS) in women with epilepsy (WWE) and develop a practical approach for PCOS screening based on clinical characteristic, blood indicator, and anti-seizure medication (ASM) profiles. This cross-sectional study was conducted with 248 WWE who were consecutively enrolled from the Epilepsy Center of West China Hospital between April 2021 and March 2022. The epilepsy characteristics, blood indicators, and use of ASMs were compared between WWE with and without PCOS. Multivariate logistic regression was used to identify the factors independently associated with PCOS. The differential analysis showed that younger age at onset of epilepsy (<13 years), a history of birth hypoxia, obesity (BMI ≥25 kg/m2 ), use of levetiracetam (LEV) (≥1 year), higher levels of cholesterol, luteinizing hormone (LH) and anti-Müllerian hormone (AMH), and lower levels of sex hormone-binding globulin were associated with PCOS (p < .05). Multivariate logistic regression identified that obesity (BMI ≥25 kg/m2 ), use of LEV (≥1 year), and higher levels of AMH and LH were independently associated with PCOS in WWE (p < .05). Obesity (BMI ≥25 kg/m2 ), LEV use (≥1 year), and elevated AMH and LH levels suggest an increased in the probability of occurrence of PCOS in WWE. The combination of these profiles provides a practical approach for screening PCOS in WWE.
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Affiliation(s)
- Wanlin Lai
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Ning Shen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Huili Zhu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Shixu He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Ximeng Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Qi Lai
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Shuming Ji
- Office of Programme Design and Statistics, Clinical Research Management Department, West China Hospital of Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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Christian CA, Reddy DS, Maguire J, Forcelli PA. Sex Differences in the Epilepsies and Associated Comorbidities: Implications for Use and Development of Pharmacotherapies. Pharmacol Rev 2021; 72:767-800. [PMID: 32817274 DOI: 10.1124/pr.119.017392] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The epilepsies are common neurologic disorders characterized by spontaneous recurrent seizures. Boys, girls, men, and women of all ages are affected by epilepsy and, in many cases, by associated comorbidities as well. The primary courses of treatment are pharmacological, dietary, and/or surgical, depending on several factors, including the areas of the brain affected and the severity of the epilepsy. There is a growing appreciation that sex differences in underlying brain function and in the neurobiology of epilepsy are important factors that should be accounted for in the design and development of new therapies. In this review, we discuss the current knowledge on sex differences in epilepsy and associated comorbidities, with emphasis on those aspects most informative for the development of new pharmacotherapies. Particular focus is placed on sex differences in the prevalence and presentation of various focal and generalized epilepsies; psychiatric, cognitive, and physiologic comorbidities; catamenial epilepsy in women; sex differences in brain development; the neural actions of sex and stress hormones and their metabolites; and cellular mechanisms, including brain-derived neurotrophic factor signaling and neuronal-glial interactions. Further attention placed on potential sex differences in epilepsies, comorbidities, and drug effects will enhance therapeutic options and efficacy for all patients with epilepsy. SIGNIFICANCE STATEMENT: Epilepsy is a common neurological disorder that often presents together with various comorbidities. The features of epilepsy and seizure activity as well as comorbid afflictions can vary between men and women. In this review, we discuss sex differences in types of epilepsies, associated comorbidities, pathophysiological mechanisms, and antiepileptic drug efficacy in both clinical patient populations and preclinical animal models.
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Affiliation(s)
- Catherine A Christian
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Doodipala Samba Reddy
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Jamie Maguire
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Patrick A Forcelli
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
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Markoula S, Siarava E, Keramida A, Chatzistefanidis D, Zikopoulos A, Kyritsis AP, Georgiou I. Reproductive health in patients with epilepsy. Epilepsy Behav 2020; 113:107563. [PMID: 33242778 DOI: 10.1016/j.yebeh.2020.107563] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/16/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Abstract
The aim of the present study was to review existing knowledge on the impact of epilepsy in reproductive health of both sexes. Extensive searches of relevant documentation published until February 2020 were retrieved from PubMed and Google Scholar literature in English or in other languages with an English abstract. In females, epilepsy may lead to estrogen and androgen level abnormalities. Women with epilepsy may develop Polycystic Ovaries Syndrome (PCOS), anovulatory cycles, and menstrual disorders. In men, epilepsy may cause sex hormone dysregulation and influence spermatogenesis. Males with epilepsy may also suffer from sexual dysfunction. Antiepileptic drugs (AEDs) have adverse effects on peripheral endocrine glands, influence hormones' biosynthesis and protein binding, diminish the bioactivity of serum sex hormones, and lead to secondary endocrine disorders related to changes concerning body weight and insulin sensitivity. Valproic acid (VPA) was the first recognized AED to cause disturbances potentially due to metabolic changes and increasing weight. Women taking VPA may develop PCOS, while men may have sperm abnormalities and/or sexual dysfunction. Liver enzyme inducing AEDs may also cause menstrual and sexual disorders in women and sexual dysfunction in men. Newer AEDs are much safer but studies still suggest reduced sexuality and erectile dysfunction.
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Affiliation(s)
- Sofia Markoula
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Eleftheria Siarava
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece.
| | - Anna Keramida
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Dimitrios Chatzistefanidis
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Athanassios Zikopoulos
- Genetics and IVF Unit, Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, Ioannina 45110, Greece
| | - Athanassios P Kyritsis
- Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece
| | - Ioannis Georgiou
- Genetics and IVF Unit, Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, Ioannina 45110, Greece
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Bosak M, Słowik A, Turaj W. Menstrual disorders and their determinants among women with epilepsy. Neuropsychiatr Dis Treat 2018; 14:2657-2664. [PMID: 30349263 PMCID: PMC6188158 DOI: 10.2147/ndt.s179438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The purpose of the present study was to assess the prevalence and determinants of menstrual cycle disorders among women with epilepsy. MATERIALS AND METHODS The study included consecutive women with epilepsy who visited a university epilepsy clinic. A number of variables, including demographics, characteristics of epilepsy and its treatment, and data related to reproductive health (regularity of menstrual cycle, number of pregnancies and childbirths), were collected from medical records, seizure diaries, and a dedicated questionnaire. RESULTS The study involved 271 women with epilepsy. Focal epilepsy was diagnosed in 182 (67.2%) patients; 108 (39.8%) women had rare seizures (<1 per year), and 164 patients (60.5%) were on monotherapy. Menstrual abnormalities were found in 78 patients (28.8%). Independent variables associated with irregular cycle included younger age at onset of epilepsy (OR=0.95 per 1-year increase; P=0.008), current use of clonazepam (OR=5.36; P=0.010), and chronic use of medication(s) other than antiepileptic drug(s) (AEDs; OR=2.48; P=0.003). Childbirth rate was low in our cohort (0.50 per patient); independent predictors of being childless in studied patients included younger age, presence of menstrual disorders, and greater number of currently used AEDs. CONCLUSION Menstrual disturbances were present in 28.8% of studied women with epilepsy. Increased prevalence of menstrual abnormalities was associated with epilepsy itself (younger age at onset of epilepsy) and its treatment (ongoing use of clonazepam), as well as with chronic use of medications other than AEDs.
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Affiliation(s)
- Magdalena Bosak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland,
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland,
| | - Wojciech Turaj
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland,
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Lai YH, Ding YJ, Moses D, Chen YH. Teratogenic Effects of Topiramate in a Zebrafish Model. Int J Mol Sci 2017; 18:ijms18081721. [PMID: 28783116 PMCID: PMC5578111 DOI: 10.3390/ijms18081721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 12/18/2022] Open
Abstract
Topiramate is commonly used for treating epilepsy in both children and adults. Recent clinical data suggests that administration of topiramate to women during pregnancy increases the risk of oral clefts in their offspring. To better understand the potential effects of topiramate, we dosed adult female zebrafish with topiramate, and investigated the altered morphologies in adult females and their offspring. It showed that topiramate-treated female fish had reduced oocyte maturation, and the survival rates of their offspring were seriously decreased during embryogenesis. In addition, around 23% of offspring displayed cartilage malformation in the craniofacial area, such as loss of ceratobranchial cartilages as well as impaired ceratohyal, Meckel’s cartilage and ethmoid plate development. Moreover, mineralization of ceratohyal, Meckel’s cartilage, and vertebrae were downregulated during bone development. Taken together, we concluded that topiramate impaired oogenesis in the maternal reproductive system, and then caused offspring cartilage malformation or bone dysplasia.
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Affiliation(s)
- Yu-Heng Lai
- Department of Chemistry, Chinese Culture University, No. 55 Huagang Road, Taipei 111, Taiwan.
| | - Yu-Ju Ding
- Department of Chemistry, Tamkang University, No. 151 Ying-chuan Road, Tamsui, New Taipei City 25137, Taiwan.
| | - David Moses
- Department of Chemistry, Tamkang University, No. 151 Ying-chuan Road, Tamsui, New Taipei City 25137, Taiwan.
| | - Yau-Hung Chen
- Department of Chemistry, Tamkang University, No. 151 Ying-chuan Road, Tamsui, New Taipei City 25137, Taiwan.
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Atif M, Sarwar MR, Scahill S. The relationship between epilepsy and sexual dysfunction: a review of the literature. SPRINGERPLUS 2016; 5:2070. [PMID: 27995047 PMCID: PMC5135706 DOI: 10.1186/s40064-016-3753-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 11/26/2016] [Indexed: 12/31/2022]
Abstract
Background and objectives Regardless of the disease states that people suffer from, maintaining sexual function is an important indicator of quality of life. The objective of this review was to figure out the relationship between epilepsy, antiepileptic drugs (AEDs) and sexual dysfunction. Results In various epidemiological and clinical studies, epilepsy has been correlated with a reduction in sexual function. This sexual dysfunction is not always detected in epileptic patients until systematic efforts are put in place, as part of the assessment and treatment process. Therefore, precise evaluations of the incidence of treatment related sexual dysfunction in epileptic patients is still lacking. Conclusions This literature review concluded that sexual function is influenced by the pathophysiology of epilepsy, as well as through the use of AEDs. To maximize quality of care in patients with epilepsy and those patients with other disease states who receive AEDs, it is important to address the status of the patient’s sexual function as part of the initial routine assessment and with any treatment related follow-up. Minimizing the effects of AED related sexual dysfunction can be achieved by raising awareness among patients, providing education and training for physicians regarding sexual dysfunction and obtaining a baseline sexual history from the patient so are important recommendations. In addition, systematic studies are needed to explore the risk and mechanism of such treatment related side effects on sexual function.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Muhammad Rehan Sarwar
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Shane Scahill
- School of Management, Massey University, Auckland, New Zealand
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Viswanathan LG, Satishchandra P, Bhimani BC, Reddy JY, Rama Murthy BS, Subbakrishna DK, Sinha S. Polycystic ovary syndrome in patients on antiepileptic drugs. Ann Indian Acad Neurol 2016; 19:339-43. [PMID: 27570385 PMCID: PMC4980956 DOI: 10.4103/0972-2327.179973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: This study aims to discuss the prevalence of polycystic ovary (PCO) and Polycystic ovary syndrome (PCOS) in women with epilepsy (WWE) on valproate (VPA), carbamazepine (CBZ), or phenobarbitone (PB), drug naive WWE and women with bipolar affective disorder (BPAD) on VPA. Materials and Methods: This prospective study included 190 women aged 18–45 years, who had epilepsy or BPAD (on VPA), and consented for study. Patients were grouped as Group 1 (n = 40): WWE on VPA, Group 2 (n = 50): WWE on CBZ, Group 3 (n = 50): WWE on PB, Group 4 (n = 30): drug naïve WWE, and Group 5 (n = 20): women with BPAD on VPA. All women were interviewed for medical, menstrual, drug and treatment history, nature of epilepsy, and seizure control. Chi-square test and Fisher's exact test were done to compare results between the groups. Results: Fifty-two women (52/190; 27.4%) had menstrual disturbances, in which oligomenorrhea was the most common (55.8%). There was a significant difference in the occurrence of PCOS in patients on VPA versus normal population (P = 0.05) and patients on other antiepileptic drugs (AEDs) (P = 0.02). There was, however, no significant difference in the occurrence of PCO between patients on VPA and the untreated epileptic women. VPA group (Epilepsy + BPAD) had a significantly higher occurrence of obesity than other treatment groups (P = 0.043, OR = 2.11). Conclusions: The study observed significantly higher occurrence of PCO in patients on VPA compared to other AEDs and the normal population. The importance of proper clinical evaluation before initiating VPA is highlighted.
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Affiliation(s)
| | | | - Bipin C Bhimani
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | | | | | | | - Sanjib Sinha
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
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Laganà AS, Triolo O, D’Amico V, Cartella SM, Sofo V, Salmeri FM, Vrtačnik Bokal E, Spina E. Management of women with epilepsy: from preconception to post-partum. Arch Gynecol Obstet 2015; 293:493-503. [DOI: 10.1007/s00404-015-3968-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 11/16/2015] [Indexed: 02/07/2023]
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Luef G, Madersbacher H. Sexual dysfunction in patients with epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:383-94. [DOI: 10.1016/b978-0-444-63247-0.00022-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Koppel BS, Harden CL. Gender issues in the neurobiology of epilepsy: A clinical perspective. Neurobiol Dis 2014; 72 Pt B:193-7. [DOI: 10.1016/j.nbd.2014.08.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023] Open
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Reynolds-May MF, Kenna HA, Marsh W, Stemmle PG, Wang P, Ketter TA, Rasgon NL. Evaluation of reproductive function in women treated for bipolar disorder compared to healthy controls. Bipolar Disord 2014; 16:37-47. [PMID: 24262071 PMCID: PMC3946814 DOI: 10.1111/bdi.12149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 06/10/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of the present study was to investigate the reproductive function of women with bipolar disorder (BD) compared to healthy controls. METHODS Women diagnosed with BD and healthy controls with no psychiatric history, aged 18-45 years, were recruited from a university clinic and surrounding community. Participants completed a baseline reproductive health questionnaire, serum hormone assessment, and ovulation tracking for three consecutive cycles using urine luteinizing hormone (LH)-detecting strips with a confirmatory luteal-phase serum progesterone. RESULTS Women with BD (n = 103) did not differ from controls (n = 36) in demographics, rates of menstrual abnormalities (MAs), or number of ovulation-positive cycles. Of the women with BD, 17% reported a current MA and 39% reported a past MA. Dehydroepiandrosterone sulfate and 17-hydroxyprogesterone levels were higher in controls (p = 0.052 and 0.004, respectively), but there were no other differences in biochemical levels. Medication type, dose, or duration was not associated with MA or biochemical markers, although those currently taking an atypical antipsychotic agent indicated a greater rate of current or past MA (80% versus 55%, p = 0.013). In women with BD, 22% reported a period of amenorrhea associated with exercising or stress, versus 8% of controls (p = 0.064). Self-reported rates of bulimia and anorexia nervosa were 10% and 5%, respectively. CONCLUSIONS Rates of MA and biochemical levels did not significantly differ between women with BD and controls. Current atypical antipsychotic agent use was associated with a higher rate of current or past MA and should be further investigated. The incidence of stress-induced amenorrhea should be further investigated in this population, as should the comorbid incidence of eating disorders.
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Affiliation(s)
- Margaret F Reynolds-May
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Heather A Kenna
- Stanford Center for Neuroscience in Women’s Health, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | - Pascale G Stemmle
- Stanford Center for Neuroscience in Women’s Health, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Po Wang
- Bipolar Disorders Clinic, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Terence A Ketter
- Bipolar Disorders Clinic, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Natalie L Rasgon
- Stanford Center for Neuroscience in Women’s Health, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Talib HJ, Alderman EM. Gynecologic and reproductive health concerns of adolescents using selected psychotropic medications. J Pediatr Adolesc Gynecol 2013; 26:7-15. [PMID: 22929762 DOI: 10.1016/j.jpag.2012.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 05/16/2012] [Accepted: 05/17/2012] [Indexed: 11/28/2022]
Abstract
Psychiatric disorders are common in adolescent girls and may require chronic therapies with psychotropic medications. Antipsychotic medications and mood stabilizers have been increasingly prescribed to and widely used by adolescents for a variety of both "on" an "off" label indications. Studies on the safety and monitoring of these medications in adolescent girls have shown important potential for gynecologic and reproductive adverse effects. The objective of this article is to review the mechanisms for and management of menstrual disorders mediated by hyperprolactinemia associated with antipsychotic medications, hypothyroidism associated with lithium and quetiapine, and the independent association of polycystic ovary syndrome (PCOS) in girls using valproic acid. Beyond their susceptibility to these disruptions in the menstrual cycle, adolescent girls with psychiatric illness also have increased sexual risk behaviors. These behaviors makes it all the more important to review teratogenicity and clinically relevant contraceptive drug interactions in adolescent girls using these psychotropic medications.
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Affiliation(s)
- Hina J Talib
- Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY 10467, USA.
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Gürgen SG, Erdoğan D, Coşkun ZK, Cansu A. The effect of valproic acid and oxcarbazepine on the distribution of adhesion molecules in embryo implantation. Toxicology 2012; 292:71-7. [DOI: 10.1016/j.tox.2011.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/17/2011] [Accepted: 11/19/2011] [Indexed: 11/30/2022]
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15
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Hu X, Wang J, Dong W, Fang Q, Hu L, Liu C. A meta-analysis of polycystic ovary syndrome in women taking valproate for epilepsy. Epilepsy Res 2011; 97:73-82. [DOI: 10.1016/j.eplepsyres.2011.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 06/14/2011] [Accepted: 07/15/2011] [Indexed: 10/17/2022]
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Verrotti A, D'Egidio C, Mohn A, Coppola G, Parisi P, Chiarelli F. Antiepileptic drugs, sex hormones, and PCOS. Epilepsia 2011; 52:199-211. [PMID: 21204821 DOI: 10.1111/j.1528-1167.2010.02897.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Reproductive endocrine dysfunction in women with epilepsy is an important issue, and in recent years there is growing evidence to support the effect on sex hormones of both epilepsy per se and various antiepileptic drugs (AEDs). Focal epileptic discharges from the temporal lobe may have a direct influence on the function of the hypothalamic-pituitary axis, thereby altering the release of sex steroid hormones. The role of laterality and severity of epilepsy is still conflicting. The use of the liver enzyme-inducing AEDs--such as phenobarbital, phenytoin, and carbamazepine--can increase serum sex hormone-binding globulin concentrations, leading to diminished bioactivity of testosterone (T) and estradiol. Valproic acid, an enzyme inhibitor, has been associated with the occurrence of reproductive endocrine disorders characterized by high serum T, free androgen index, androstenedione, dehydroepiandrosterone sulfate concentrations, and with polycystic changes in ovaries and menstrual disorders. A better understanding of the effects of AEDs on sex hormones is key to selecting the appropriate AEDs and is crucial for reproductive health in female patients.
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Harden CL. Polycystic ovaries and polycystic ovary syndrome in epilepsy: evidence for neurogonadal disease. Epilepsy Curr 2010; 5:142-6. [PMID: 16151523 PMCID: PMC1198730 DOI: 10.1111/j.1535-7511.2005.00039.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a mysterious reproductive disorder that results in subfertility. The underlying causes are not known, and even the definition is a moving target. Women with epilepsy have features of PCOS at a higher than expected rate, and polycystic ovaries (PCO) also are present at high rates in this population. Valproate is associated with weight gain and increased androgen levels, two features of PCOS. This review proposes that epilepsy, with its known adverse effects on luteinizing hormone pulsatility, could be a cause of PCOS and that valproate could be an imitator, if not also a cause of the syndrome.
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Affiliation(s)
- Cynthia L Harden
- Department of Neurology and Neuroscience, Weill Medical College Cornell University, New York Presbyterian Hospital, New York City, NY, USA
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LaCour DE, Long DN, Perlman SE. Dysfunctional uterine bleeding in adolescent females associated with endocrine causes and medical conditions. J Pediatr Adolesc Gynecol 2010; 23:62-70. [PMID: 20347757 DOI: 10.1016/j.jpag.2009.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 06/01/2009] [Accepted: 06/16/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Delese E LaCour
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville, Louisville, Kentucky, USA.
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Verrotti A, D'Egidio C, Coppola G, Parisi P, Chiarelli F. Epilepsy, sex hormones and antiepileptic drugs in female patients. Expert Rev Neurother 2010; 9:1803-14. [PMID: 19951139 DOI: 10.1586/ern.09.112] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Women with epilepsy have a higher incidence of reproductive endocrine disorders than the general female population. These alterations include polycystic ovary syndrome, hyperandrogenemia, infertility, hypothalamic amenorrhea and hyperprolactinemia. Reproductive dysfunction is attributed both to epilepsy itself and to antiepileptic drugs (AEDs). Focal epileptic discharges from the temporal lobe may have a direct influence on the function of the hypothalamic-pituitary axis, thus altering the release of sex steroid hormones, including the production of luteinizing hormone, follicle-stimulating hormone, gonadotropin-releasing hormone and prolactin. AEDs may modulate hormone release from the hypothalamic-pituitary-gonadal axis and they may alter the metabolism of sex hormones and their binding proteins. Hepatic enzyme-inducing AEDs, such as carbamazepine and phenytoin, may be most clearly linked to altered metabolism of sex steroid hormones, but valproic acid, an enzyme inhibitor, has also been associated with a frequent occurrence of polycystic ovary syndrome and hyperandrogenism in women with epilepsy. Therefore, treatment of epilepsy and selection of AEDs are important for reproductive health in female patients. The aim of the present review is to critically evaluate the recently published data concerning the interactions between sex hormones, epilepsy and AEDs.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of Chieti, Via dei Vestini 5, 66100 Chieti, Italy.
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Fisseha S, Towns R, Harada M, Peegel H, Menon KMJ. Inhibitory effect of valproic acid on ovarian androgen biosynthesis in rat theca-interstitial cells. Endocrine 2010; 37:187-93. [PMID: 20963569 PMCID: PMC2963034 DOI: 10.1007/s12020-009-9287-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 11/16/2009] [Indexed: 10/20/2022]
Abstract
The objective of the study was to evaluate the effect of valproic acid (VPA) on ovarian androgen biosynthesis in primary cultures of theca-interstitial (T-I) cells isolated from rat ovaries. Ovarian T-I cells were cultured with VPA in the presence or absence of hCG. VPA did not increase basal or hCG-stimulated androgen synthesis when added to primary cultures of T-I cells. However, the addition of VPA caused a marked concentration-dependent inhibitory effect on hCG-stimulated androstendione synthesis. Treatment of T-I cells with 8-Bromo-cAMP resulted in a marked increase in the production of androstenedione, and VPA inhibited this stimulatory effect, suggesting that the mechanism of VPA's inhibitory effect on androstenedione production occurs at a step after second messenger activation. Treatment of T-I cells with hCG resulted in a significant increase in the mRNA expression of steroidogenic enzymes CYP17A1 and 17β-hydroxysteroid dehydrogenase. Addition of VPA sharply blunted the stimulatory effect of hCG, reducing the mRNA expression of the steroidogenic enzymes to basal levels. In conclusion, VPA exerts an inhibitory effect on hCG-stimulated androgen synthesis in rat T-I cells.
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Affiliation(s)
- Senait Fisseha
- Department of Obstetrics/Gynecology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Roberto Towns
- Department of Obstetrics/Gynecology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Miyuki Harada
- Department of Obstetrics/Gynecology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Helle Peegel
- Department of Obstetrics/Gynecology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - K. M. J. Menon
- Department of Obstetrics/Gynecology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- University of Michigan Medical School, 6428, Medical Science I, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, USA
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Abstract
Women with epilepsy face additional challenges when compared to their peers. Hormonal influences may increase seizure activity, alter endocrine function, and affect fertility. In this population, antiepileptic drugs (AEDs) reduce the efficacy of contraception methods and increase the risk of fetal malformations. Other pertinent issues to women with epilepsy include breastfeeding as well as bone mineral health. This article summarizes our current, collective knowledge of these issues and makes specific recommendations with respect to management.
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Affiliation(s)
- Sunila E O'Connor
- Department of Neurology, Section of Child Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Taubøll E, Gregoraszczuk EL, Wojtowicz AK, Milewicz T. Effects of levetiracetam and valproate on reproductive endocrine function studied in human ovarian follicular cells. Epilepsia 2009; 50:1868-74. [DOI: 10.1111/j.1528-1167.2009.02131.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Murialdo G, Magri F, Tamagno G, Ameri P, Camera A, Colnaghi S, Perucca P, Ravera G, Galimberti CA. Seizure frequency and sex steroids in women with partial epilepsy on antiepileptic therapy. Epilepsia 2009; 50:1920-6. [DOI: 10.1111/j.1528-1167.2009.02178.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The focus on gender-related issues for women with epilepsy has heightened in recent years. The emphasis, however, has been on the childbearing years. Epilepsy and antiepileptic drug treatment affect sexual development, the menstrual cycle, and aspects of contraception, fertility, and reproduction. Female patients with epilepsy at a reproductive age face a unique set of reproductive issues, ranging from descriptions of disorders of reproduction in epilepsy and its causes, to contraception, pregnancy, sexuality, menopause, and osteoporosis. Conditions and diseases that specifically affect women are discussed. The role of hormones across the life cycle--endogenous and exogenous hormones and their effects on drug interactions, drug metabolism, and therapeutic outcomes--is described. Contraception and pregnancy issues for women with epilepsy have received the appropriate attention.
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Affiliation(s)
- Gerhard Luef
- Department of Neurology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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Hum KM, Megna S, McIntyre Burnham W. The effects of right and left amygdala kindling on the female reproductive system in rats. Epilepsia 2009; 50:880-6. [DOI: 10.1111/j.1528-1167.2008.01982.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Catamenial epilepsy is defined by the cyclical seizure exacerbation seen in almost 40% of women with epilepsy. The pattern appears to be related to predominance of estrogen over progesterone during the pre-ovulatory and/or perimenstrual days of the ovulatory menstrual cycle or during the broad period between day 14 and menstruation in anovulatory cycles with inadequate luteal progesterone levels. Progesterone affects central nervous excitability in an "inhibitory" manner, slowing kindling and decreasing seizure susceptibility in animal models. Estrogen enhances kindling and decreases after discharge threshold. These neurosteroidal hormones alter the GABA-A receptor in cell cultures and in animal models. Treatment of this clinical syndrome has been empirical and reported in a small series of women. Progesterone therapy and possible new approaches with synthesized neurosteroids may offer a promising approach to improve seizure control in women with catamenial epilepsy.
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Affiliation(s)
- Patricia E Penovich
- Minnesota Epilepsy Group PA, Department of Neurology, University of Minnesota, Minnesota 55102, USA
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Scharfman HE, Kim M, Hintz TM, MacLusky NJ. Seizures and reproductive function: insights from female rats with epilepsy. Ann Neurol 2009; 64:687-97. [PMID: 19107990 DOI: 10.1002/ana.21518] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Chronic seizures in women can have adverse effects on reproductive function, such as polycystic ovarian syndrome, but it has been difficult to dissociate the effects of epilepsy from the role of antiepileptic drugs. To distinguish the effects of chronic seizures from medication, we used the laboratory rat, because an epileptic condition can be induced without concomitant anticonvulsant drug treatment. METHODS Adult female rats were administered the chemoconvulsant pilocarpine to initiate status epilepticus, which was decreased in severity by the anticonvulsant diazepam. These rats developed spontaneous seizures in the ensuing weeks, and are therefore termed epileptic. Controls were saline-treated rats, or animals that were injected with pilocarpine but did not develop status epilepticus. Ovarian cyclicity and weight gain were evaluated for 2 to 3 months. Serum hormone levels were assayed from trunk blood, which was collected at the time of death. Paraformaldehyde-fixed ovaries were evaluated quantitatively. RESULTS Rats that had pilocarpine-induced seizures had an increased incidence of acyclicity by the end of the study, even if status epilepticus did not occur. Ovarian cysts and weight gain were significantly greater in epileptic than control rats, whether rats maintained cyclicity or not. Serum testosterone was increased in epileptic rats, but estradiol, progesterone, and prolactin were not. INTERPRETATIONS The results suggest that an epileptic condition in the rat leads to increased body weight, cystic ovaries, and increased testosterone levels. Although caution is required when comparing female rats with women, the data suggest that recurrent seizures have adverse effects, independent of antiepileptic drugs.
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Affiliation(s)
- Helen E Scharfman
- Center for Dementia Research, The Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA.
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Galimberti CA, Magri F, Copello F, Arbasino C, Chytiris S, Casu M, Ameri P, Perucca P, Murialdo G. Changes in sex steroid levels in women with epilepsy on treatment: Relationship with antiepileptic therapies and seizure frequency. Epilepsia 2009; 50 Suppl 1:28-32. [DOI: 10.1111/j.1528-1167.2008.01966.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sahota P, Prabhakar S, Kharbanda PS, Bhansali A, Jain V, Das CP, Modi M. Seizure type, antiepileptic drugs, and reproductive endocrine dysfunction in Indian women with epilepsy: A cross-sectional study. Epilepsia 2008; 49:2069-77. [PMID: 18503558 DOI: 10.1111/j.1528-1167.2008.01676.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Valproate (VPA) is a highly effective drug successfully employed in several neuropsychiatric diseases. In the last 15 years, an increased prevalence of polycystic ovary syndrome (PCOS) associated with VPA use has been reported in both women with epilepsy and women with bipolar disorders. However, data on this subject are contrasting and it is possible that different factors might play a role in the development of PCOS in these patients. The risk of developing PCOS during VPA treatment seems to be higher in women with epilepsy than in women with bipolar disorders, and this might be due to an underlying neuroendocrine dysfunction related to the seizure disorder. Gynecologists must be aware of the possibility that PCOS in these populations of patients might be related to VPA use, and a careful multi-specialist approach is required for evaluating the risks and benefits of this treatment in the presence of features of PCOS.
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Affiliation(s)
- Leonilda Bilo
- Epilepsy Center, Department of Neurological Sciences, Federico II University, Naples, Italy.
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Joffe H, Hayes FJ. Menstrual cycle dysfunction associated with neurologic and psychiatric disorders: their treatment in adolescents. Ann N Y Acad Sci 2008; 1135:219-29. [PMID: 18574228 DOI: 10.1196/annals.1429.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Epilepsy, bipolar disorder, and migraines are common disorders that are often associated with disturbances in menstrual function in adolescent girls. Women with untreated epilepsy are more likely to have irregular menstrual cycles than are nonepileptic controls, indicating that the disease itself plays a role in the etiology of these reproductive abnormalities. In addition, many girls with these disorders require chronic maintenance treatment with agents that may perturb the hypothalamic-pituitary-ovarian axis. Valproate is a highly effective antiepileptic drug used widely to treat epilepsy, bipolar disorder, and migraines. Valproate induces features of the polycystic ovary syndrome (PCOS) in approximately 7% of women. Girls with epilepsy, and possibly bipolar disorder, appear particularly susceptible to developing PCOS features on valproate, perhaps on account of the relative immaturity of their hypothalamic-pituitary-ovarian axes. Antipsychotics are highly effective drugs used widely to treat adolescents with bipolar disorder, psychotic disorders, and behavioral disturbances. Some, but not all of the antipsychotic, induce hyperprolactinemia, which may result in oligo- or amenorrhea. Prolonged amenorrhea in association with hyperprolactinemia incurs significant risks for bone health in adolescent girls. Because of the potential reproductive health risks associated with use of specific antiepileptic drugs and selective antipsychotics, these agents are vital treatments for adolescents with severe illnesses. Use of these agents should be considered and weighed against the risk of using alternative agents, which have their own side effects, or not treating these serious neurologic and psychiatric disorders.
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Affiliation(s)
- Hadine Joffe
- Perinatal and Reproductive Psychiatry, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
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Morrell MJ, Hayes FJ, Sluss PM, Adams JM, Bhatt M, Ozkara C, Warnock M.S. CR, Isojärvi J. Hyperandrogenism, ovulatory dysfunction, and polycystic ovary syndrome with valproate versus lamotrigine. Ann Neurol 2008; 64:200-11. [DOI: 10.1002/ana.21411] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Cansu A, Giray SG, Serdaroglu A, Erdogan D, Coskun ZK, Korucuoglu U, Biri AA. Effects of chronic treatment with valproate and oxcarbazepine on ovarian folliculogenesis in rats. Epilepsia 2008; 49:1192-201. [DOI: 10.1111/j.1528-1167.2008.01576.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lossius MI, Taubøll E, Mowinckel P, Mørkrid L, Gjerstad L. Reversible Effects of Antiepileptic Drugs on Reproductive Endocrine Function in Men and Women with Epilepsy?A Prospective Randomized Double-Blind Withdrawal Study. Epilepsia 2007; 48:1875-82. [PMID: 17555526 DOI: 10.1111/j.1528-1167.2007.01147.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Epilepsy, antiepileptic drugs (AEDs), and reproductive endocrine function have complex interactions. In this study, we wanted to investigate the effects of AEDs on reproductive endocrine function after withdrawal of AEDs and look for reversible endocrine effects. METHODS The study was prospective, randomized, and double-blinded. A total of 160 patients were included and randomized to withdrawal or not and 150 (80 females, 53%) patients went through the intervention and was included in the study for 12 months. Complete serum samples from before and 4 months after completed withdrawal/no withdrawal were obtained from 130 patients (63 females, 48%). RESULTS The main finding was that reversible endocrine changes in sex steroid hormone levels could be observed in both sexes after withdrawal of AEDs. For CBZ, which was the drug used by the majority of the patients, withdrawal led to significant increases in serum testosterone concentrations and free androgen index (FAI) in both men (n = 19) and women (n = 19). Mean differences in change in FAI between the withdrawal group and nonwithdrawal group were in men 17.49 (CI 10.16-24.81, p <or= 0.001), and in women 1.61 (CI 0.62-2.61, p <or= 0.001). CONCLUSION Our findings provide further evidence of the potentially negative effects of CBZ treatment on reproductive endocrine functions in men and women, but also show that some of these changes may be reversible, even after years on treatment.
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Affiliation(s)
- Morten I Lossius
- Helse Øst Health Services Research Centre, Akershus University Hospital, Lorenskog, Norway.
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36
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Kalinin VV, Zheleznova EV. Chronology and evolution of temporal lobe epilepsy and endocrine reproductive dysfunction in women: relationships to side of focus and catameniality. Epilepsy Behav 2007; 11:185-91. [PMID: 17573242 DOI: 10.1016/j.yebeh.2007.04.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Revised: 04/07/2007] [Accepted: 04/13/2007] [Indexed: 11/16/2022]
Abstract
The current study was carried out to determine the possible associations between side of focus, catameniality, reproductive dysfunction (RD), and chronology variables for epilepsy and concomitant RD in women. Eighty women of childbearing potential with temporal lobe epilepsy were included in the study. Catamenial epilepsy was observed mainly in women with left-sided foci, and a noncatamenial pattern in women with right-sided foci. Left-sided foci were associated with polycystic ovary syndrome, and right-sided foci with hypogonadotropic hypogonadism. Catamenial epilepsy with right-sided foci was associated with longer duration of epilepsy (P=0.021), trend toward earlier age at onset of epilepsy, and trend toward longer interval between onset of epilepsy and onset of RD compared with catamenial epilepsy with left-sided foci. On the other hand, noncatamenial epilepsy with right-sided foci was characterized by a shorter interval between onset of epilepsy and onset of RD in comparison with noncatamenial epilepsy with left-sided activity (P=0.03). In addition, comparison of patients with right-sided foci with catamenial and noncatamenial patterns of seizures revealed earlier age of epilepsy onset (P=0.049), longer duration of epilepsy (P=0.017) and of RD (P=0.036), and longer interval between onset of epilepsy and onset of RD (P=0.048) in patients with catamenial epilepsy. From an evolutionary point of view, catamenial epilepsy with right-sided focal activity seems to be the oldest subtype.
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Affiliation(s)
- Vladimir V Kalinin
- Department of Brain Organic Disorders and Epilepsy, Moscow Research Institute of Psychiatry, Ministry of Health and Social Development, Moscow, Russian Federation.
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Vajda FJE. Pharmacotherapy of epilepsy: new armamentarium, new issues. J Clin Neurosci 2007; 14:813-23. [PMID: 17618119 DOI: 10.1016/j.jocn.2007.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 01/29/2007] [Accepted: 02/04/2007] [Indexed: 10/23/2022]
Abstract
Since 1990 there have been over ten antiepileptic drugs (AEDs) approved for the therapy of epilepsy. These agents have a new spectrum of efficacy and novel adverse effects, some totally unexpected. They also represent an enormous escalation of costs. Few have been subjected to head-to-head comparisons in monotherapy against established AEDs. The aim of therapy is to eliminate rather than to reduce seizure manifestations. Many traditional agents have been phased out due to poor tolerability. New epilepsy syndromes and genetic contributions to epilepsy have been refined. Special considerations apply to various classes of sufferers such as the elderly, women of childbearing age, and sufferers with concomitant disorders, treated with medications capable of drug interactions. There is a recognition of the value of slow introduction, a preference for monotherapy, recognition of the effects of AEDs on hormones and reproductive function and effects on the fetus exposed to AEDs in utero, comprising physical malformations and effects on cognitive development. A balance between efficacy and safety is pivotal, as every preference about the initial pharmacotherapy of epilepsy and subsequent polytherapy has its protagonists. With improvement in diagnostic techniques and new therapeutic modalities it is likely that in the future, pharmacogenomics and an understanding of pharmacoresistance may influence drug selection for individual patients with epilepsy.
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Affiliation(s)
- Frank J E Vajda
- Department of Medicine, Monash University and Medical Centre, 246 Clayton Road, Clayton 3168, Victoria, and Department of Medicine, St Vincents Hospital, Melbourne, Australia.
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de Vries L, Karasik A, Landau Z, Phillip M, Kiviti S, Goldberg-Stern H. Endocrine effects of valproate in adolescent girls with epilepsy. Epilepsia 2007; 48:470-7. [PMID: 17326798 DOI: 10.1111/j.1528-1167.2006.00953.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the effect of epilepsy and/or valproate (VPA) monotherapy on physical growth, weight gain, pubertal development, and hormonal status in adolescent girls with epilepsy. METHODS The study group included 88 consecutive female patients with epilepsy aged 6-20 years (28 premenarche, 60 postmenarche) attending an endocrinology institute of a major tertiary center. Forty-five patients were under treatment with VPA, and 43 were before treatment initiation. The groups were compared for the relevant biochemical, anthropometric, ultrasonographic, and endocrine parameters. RESULTS No statistically significant differences were found in any of the parameters studied between the groups, as a whole or by menarche status. The treated postmenarcheal subgroup had a higher mean testosterone level than the untreated postmenarcheal controls (1.83 +/- 0.65 vs. 0.88 +/- 0.24, p=0.006). Body mass index--standard deviation score (BMI-SDS) was 0.75 in the treated group and 0.63 in the untreated group; rates of obesity were 16.3% and 15.5%, respectively. No between-group differences were found in menses irregularities, hirsutism, or acne. No correlation was found between duration or dosage of treatment and BMI-SDS, height-SDS, or androgen level. The treated group had higher levels of thyroid-stimulating hormone and lower levels of free thyroxine than did the untreated group, although still within normal range. CONCLUSIONS Long-term treatment with VPA in girls with epilepsy is associated with increased testosterone levels after menarche, without clinical hyperandrogenism, polycystic ovary syndrome, or an increase in BMI-SDS. VPA is a good treatment option in this age group but should be accompanied by careful endocrine observation.
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Affiliation(s)
- Liat de Vries
- Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Petah Tiqwa, Israel
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Löfgren E, Mikkonen K, Tolonen U, Pakarinen A, Koivunen R, Myllyla VV, Tapanainen JS, Isojärvi JIT. Reproductive endocrine function in women with epilepsy: the role of epilepsy type and medication. Epilepsy Behav 2007; 10:77-83. [PMID: 17098479 DOI: 10.1016/j.yebeh.2006.09.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Revised: 09/26/2006] [Accepted: 09/27/2006] [Indexed: 10/23/2022]
Abstract
The purpose of the analysis described here was to assess reproductive endocrine disorders in 148 women with epilepsy (WWE) by epilepsy type and antiepileptic drug use. Women with idiopathic generalized epilepsy had a higher prevalence of reproductive endocrine disorders than control subjects. In addition, hyperandrogenism, polycystic ovaries, and polycystic ovary syndrome were more prevalent in WWE on valproate than in WWE taking other drugs or control women. The use of VPA was a predictor of the development of polycystic ovaries and polycystic ovary syndrome, and the use of valproate and younger age predicted the development of hyperandrogenism. In conclusion, both idiopathic generalized epilepsy and valproate were associated with an increased risk of reproductive endocrine disorders in WWE in this post hoc reanalysis of data on a large number of WWE. This was especially evident if the epilepsy was active and required treatment early in life.
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Affiliation(s)
- Eeva Löfgren
- Department of Neurology, University of Oulu, Oulu, Finland.
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Hamed SA, Hamed EA, Shokry M, Omar H, Abdellah MM. The reproductive conditions and lipid profile in females with epilepsy. Acta Neurol Scand 2007; 115:12-22. [PMID: 17156261 DOI: 10.1111/j.1600-0404.2006.00740.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore the reproductive conditions in women with epilepsy. METHODS Eighty-eight women were included; 37.5% and 62.5% had generalized and partial epilepsies, respectively. Ovarian sonogram, reproductive hormone and lipid profiles were assessed. RESULTS Compared with the control group and in accordance with our laboratory reference values, irregular menses and polycystic ovaries (PCO(s)) were reported in 70.5% and 39.8% versus 21.7% and 16.7% of controls. Abnormalities in leutinizing hormone (LH), follicle-stimulating hormone (FSH), LH-to-FSH ratio, testosterone (T) and prolactin (PRL) were identified. High values of FSH, LH and FSH-to-LH ratio were common with carbamazepine while that of T and PRL were common in untreated patients and with valproate. Low levels of high-density lipoprotein cholesterol was identified in approximately 59% but neither associated with duration and type of antiepileptic drugs nor patients' age, hormonal profile or PCO(s). Significant correlation was identified between menatrual irregularities, T, PRL, hormonal, lipid profile alterations, PCO(s) and seizure frequency but neither with epilepsy type nor focus. CONCLUSION This is the first study in our country that aimed at evaluation of reproductive conditions in women with epilepsy. This study indicates that reproductive dysfunction is common, hence, characterization of seizure-associated neuroendocrine adverse effects is important while managing women particularly during choice of antiepileptic medications as initial step and during patients' follow-up.
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Affiliation(s)
- S A Hamed
- Department of Neurology, Assiut University, Assiut, Egypt.
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Löfgren E, Tapanainen JS, Koivunen R, Pakarinen A, Isojärvi JIT. Effects of carbamazepine and oxcarbazepine on the reproductive endocrine function in women with epilepsy. Epilepsia 2006; 47:1441-6. [PMID: 16981858 DOI: 10.1111/j.1528-1167.2006.00506.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of the study was to compare the effects of carbamazepine (CBZ) and oxcarbazepine (OXC) on the reproductive endocrine function in women with epilepsy. OXC is a novel antiepileptic drug (AED), and the occurrence of reproductive dysfunction in women treated with OXC monotherapy for epilepsy has not been studied previously. METHODS Thirty-five women with epilepsy were examined in the Department of Neurology at Oulu University Hospital. Sixteen patients were treated with CBZ monotherapy, and nineteen patients were treated with OXC monotherapy. The subjects were clinically examined, vaginal ultrasonography was performed, and serum sex hormone concentrations were measured. RESULTS The women taking CBZ or OXC had lower serum testosterone (T) levels and lower free androgen indexes (FAIs) than the control subjects. CBZ medication was associated with increased concentrations of serum sex hormone-binding globulin (SHBG). The patients taking OXC had higher concentrations of dehydroepiandrosterone sulfate (DHEAS) and androstendione (A) than did the women taking CBZ. Moreover, the prevalence of polycystic ovaries (PCOs) was high in the OXC-treated women. CONCLUSIONS CBZ and OXC have different effects on the reproductive endocrine function. Although both drugs were associated with low serum T concentrations and low FAIs, only OXC was associated with a high frequency of elevated levels of A and DHEAS and with an increased prevalence of PCOs. These findings suggest that OXC may be disadvantageous for women with epilepsy and hyperandrogenism, whereas CBZ may be beneficial for these women.
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Affiliation(s)
- Eeva Löfgren
- Department of Neurology, University of Oulu, Oulu, Finland.
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Abstract
Women with epilepsy should not be discouraged from becoming pregnant as the likelihood of having a healthy baby is very high. However, in such women, early and individualised counselling about pregnancy and contraception is essential. Ideally, pregnancies should be planned, folic acid (5 mg/day) given and antiepileptic drug (AED) treatment optimised well before conception to ensure that the lowest dosage that controls seizures is administered. When initiating AEDs in a woman of childbearing age, the most appropriate drug for the seizure type and syndrome should be chosen, although it is preferable to avoid valproate, because of a possible elevated risk of fetal malformations, when equi-effective agents are available for a given syndrome. In women who become pregnant while taking AEDs, fetal monitoring should include high-resolution ultrasonography before week 20 and measurement of serum alpha-fetoprotein levels. Amniocentesis is not routinely indicated. The measurement of blood concentrations of AEDs can be useful to ensure that the lowest possible maintenance dosage is being used, especially for those drugs whose pharmacokinetics are likely to change during pregnancy. Breastfeeding should be encouraged whatever the treatment administered.
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Bloom MS, Schisterman EF, Hediger ML. Selecting controls is not selecting “normals”: Design and analysis issues for studying the etiology of polycystic ovary syndrome. Fertil Steril 2006; 86:1-12. [PMID: 16750830 DOI: 10.1016/j.fertnstert.2005.09.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 09/01/2005] [Accepted: 09/01/2005] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is a highly prevalent disorder among postmenarcheal premenopausal women, accounting for much of anovulatory infertility, and it is associated with several comorbidities. The natural history of PCOS, as well as hypotheses regarding its etiology, facilitates employment of the case-control study design. However, a review of the literature suggested that inconsistency of research findings in relation to the etiology of PCOS might be, in part, due to the different choice of controls for case-control design and application. DESIGN Investigators have often employed "healthy" control groups and neglected to consider the tenability of the "rare disease" assumption in the analysis when instituting the case-control strategy. This might result in the introduction of a positive bias or overestimation of odds ratios, producing an effect estimate that is more extreme than that in the underlying population. Using several quantitative, though hypothetical, literature-driven examples, this bias is described and demonstrated. In addition, recommendations are provided with regard to case-sampling strategy when the rare disease assumption is untenable, as it may frequently be in studies of PCOS. CONCLUSION(S) It is hoped that more consistent case-control methodology, in concert with recent consensus on case definition, will more effectively facilitate the elucidation of the causes and consequences of PCOS.
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Affiliation(s)
- Michael S Bloom
- Epidemiology Branch, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Joffe H, Cohen LS, Suppes T, McLaughlin WL, Lavori P, Adams JM, Hwang CH, Hall JE, Sachs GS. Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder. Biol Psychiatry 2006; 59:1078-86. [PMID: 16448626 DOI: 10.1016/j.biopsych.2005.10.017] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 07/15/2005] [Accepted: 10/18/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Preliminary evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS), while contradictory data support an association between epilepsy and PCOS. The development of PCOS features after initiation of valproate was therefore examined in women with bipolar disorder using a standardized definition of PCOS. METHODS Three hundred women 18 to 45 years old with bipolar disorder were evaluated for PCOS at 16 Systematic Treatment Enhancement for Bipolar Disorder sites. A comparison was made between the incidence of hyperandrogenism (hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other anticonvulsants (lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. Medication and menstrual cycle histories were obtained, and hyperandrogenism was assessed. RESULTS Among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate and in 2 (1.4%) of 144 women on a nonvalproate anticonvulsant or lithium (relative risk 7.5, 95% confidence interval [CI] 1.7-34.1, p = .002). Oligoamenorrhea always began within 12 months of valproate use. CONCLUSIONS Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism. Monitoring for reproductive-endocrine abnormalities is important when starting and using valproate in reproductive-aged women. Prospective studies are needed to elucidate risk factors for development of PCOS on valproate.
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Affiliation(s)
- Hadine Joffe
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Death AK, McGrath KCY, Handelsman DJ. Valproate is an anti-androgen and anti-progestin. Steroids 2005; 70:946-53. [PMID: 16165177 DOI: 10.1016/j.steroids.2005.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Revised: 07/08/2005] [Accepted: 07/13/2005] [Indexed: 11/27/2022]
Abstract
Anti-convulsant treatment is associated with a high prevalence of reproductive dysfunction compared with age-matched non-epileptics. We examined the widely used anti-convulsants valproate (VPA) and carbamazepine (CBZ) for steroidal bioactivity using a yeast-based steroid receptor-beta-galactosidase reporter assay for the androgen receptor (AR), progesterone receptor (PR) or estrogen receptor (ER). Bioassays were performed (a) to detect agonist activity by exposing yeast to 100 microM CBZ or VPA or (b) to detect antagonist activity by exposing yeast stimulated with testosterone (5 x 10(-9) M, AR), progesterone (1.6 x 10(-9) M, PR) or estradiol (2.6 x 10(-11) M, ER) together with either VPA or CBZ for 4 (PR) or 16 (AR, ER) hours. VPA showed dose-dependent (1-800 microM) inhibition of progesterone-induced PR- and testosterone-induced AR activity but had no ER antagonist bioactivity and no significant PR, AR or ER agonist bioactivity. VPA also showed a dose-dependent (1-200 microM) blockade of DHT's suppression of AR-mediated NF-kappaB activation in human mammalian cells. By contrast, CBZ had no significant PR, AR or ER agonist or AR and ER antagonist bioactivity but at the highest concentration tested (800 microM) it did antagonize PR activity. We conclude that VPA is a non-steroidal antagonist for human AR and PR but not ER. VPA's androgen and progesterone antagonism at concentrations within therapeutic blood levels (350-700 microM) seems likely to contribute to the frequency of reproductive endocrine disturbances among patients treated with VPA.
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Affiliation(s)
- Alison K Death
- Heart Research Institute, 145 Missenden Road, Camperdown, NSW 2050, Australia.
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Rasgon NL, Reynolds MF, Elman S, Saad M, Frye MA, Bauer M, Altshuler LL. Longitudinal evaluation of reproductive function in women treated for bipolar disorder. J Affect Disord 2005; 89:217-25. [PMID: 16171873 DOI: 10.1016/j.jad.2005.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 08/03/2005] [Accepted: 08/10/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND We assessed reproductive endocrine and metabolic markers in women treated for bipolar disorder over a 2-year time period, controlling for valproate use. METHODS Twenty-five women ages 18-45 with bipolar disorder underwent longitudinal evaluations. Subjects completed a reproductive health questionnaire and endocrinological exam at baseline. Total and free testosterone, progesterone, LH, FSH, fasting insulin and glucose, and other hormones were measured across the menstrual cycle at baseline and at 2-year follow-up. RESULTS Ten subjects were currently receiving valproate as a mood stabilizing agent; of the remaining subjects, six received lithium and five received atypical antipsychotics. Of all subjects, 41.7% reported current oligomenorrhea, while 40% reported oligomenorrhea before starting medication. Rates of oligomenorrhea and clinical hyperandrogenism did not differ by medication use. Eighty percent of women had a high homeostatic model assessment of insulin resistance (HOMA-IR) at baseline; all other measures were normal. Over time, all subjects exhibited a significant decrease in luteal phase progesterone and increase in free testosterone concentrations. Valproate use was associated with an increase over time in total testosterone. Baseline values and changes in BMI were similar across groups. LIMITATIONS Limitations include small sample size and the absence of a control group. CONCLUSION We confirm our previous observations of high rates of menstrual abnormalities, hyperandrogenemia and insulin resistance in women with bipolar disorder. These results tentatively support the role of valproate in hyperandrogenemia; however, rates of oligomenorrhea and clinical hyperandrogenism did not differ between medication groups.
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Affiliation(s)
- Natalie L Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, 401 Quarry Road, Palo Alto, Ca 94305-5723 Stanford, California, United States.
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Rasgon NL, Altshuler LL, Fairbanks L, Elman S, Bitran J, Labarca R, Saad M, Kupka R, Nolen WA, Frye MA, Suppes T, McElroy SL, Keck PE, Leverich G, Grunze H, Walden J, Post R, Mintz J. Reproductive function and risk for PCOS in women treated for bipolar disorder. Bipolar Disord 2005; 7:246-59. [PMID: 15898962 DOI: 10.1111/j.1399-5618.2005.00201.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This study examined the reproductive function and prevalence of polycystic ovary syndrome (PCOS) in women with bipolar disorder taking antimanic medications. METHOD Women aged 18-45 treated for bipolar disorder and not taking steroid contraceptives were recruited to complete questionnaires about their menstrual cycle and to provide blood samples for measurement of a range of reproductive endocrine and metabolic hormone levels. Eighty women participated in completing the questionnaires and 72 of them provided blood samples. RESULTS Fifty-two of the 80 women (65%) reported current menstrual abnormalities, 40 of which (50%) reported one or more menstrual abnormalities that preceded the diagnosis of bipolar disorder. Fifteen women (38%) reported developing menstrual abnormalities since treatment for bipolar disorder, 14 of which developed abnormalities since treatment with valproate (p = 0.04). Of the 15 patients reporting menstrual abnormalities since starting medication, 12 (80%) reported changes in menstrual flow (heavy or prolonged bleeding) and five (33%) reported changes in cycle frequency. No significant differences were observed between women receiving or not receiving valproate in mean levels of free or total serum testosterone levels. This was true for the total sample and for the sub-group without preexisting menstrual problems. However, within the valproate group, duration of use was significantly correlated with free testosterone levels (r = 0.33, p = 0.02). Three of the 50 women (6%) taking VPA, and 0% of the 22 taking other antimanic medications, met criteria for PCOS (p = 0.20). Other reproductive and metabolic values outside the normal range across treatment groups included elevated 17 alpha-OH progesterone levels, luteinizing hormone: follicle-stimulating hormone ratios, homeostatic model assessment (HOMA) values, and low estrogen and dehydroepiandrosterone sulfate (DHEAS) levels. Preexisting menstrual abnormalities predicted higher levels of 17 alpha-OH progesterone, free testosterone, and estrone as well as development of new menstrual abnormalities. Body mass index (BMI) was significantly positively correlated with free testosterone levels and insulin resistance (HOMA) across all subjects, regardless of medication used. CONCLUSIONS Rates of menstrual disturbances are high in women with bipolar disorder and, in many cases, precede the diagnosis and treatment for the disorder. Treatment with valproate additionally contributes significantly to the development of menstrual abnormalities and an increase in testosterone levels over time. A number of bipolar women, regardless of type of medication treatment received, have reproductive and metabolic hormonal abnormalities, yet the etiology of such abnormalities requires further study. Women with preexisting menstrual abnormalities may represent a group at risk for development of reproductive dysfunction while being treated for bipolar disorder.
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Affiliation(s)
- Natalie L Rasgon
- Department of Psychiatry, Stanford School of Medicine, Palo Alto, CA, USA.
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Isojärvi JIT, Taubøll E, Herzog AG. Effect of antiepileptic drugs on reproductive endocrine function in individuals with epilepsy. CNS Drugs 2005; 19:207-23. [PMID: 15740176 DOI: 10.2165/00023210-200519030-00003] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
It is well known that epilepsy, antiepileptic drugs (AEDs), and the reproductive system have complex interactions. Fertility is lower in both men and women with epilepsy than in the general population. Moreover, reproductive endocrine disorders are more common among patients with epilepsy than among the population in general. These disorders have been attributed both to epilepsy itself and to use of AEDs. The use of the liver enzyme-inducing AEDs phenobarbital, phenytoin and carbamazepine increases serum sex hormone-binding globulin (SHBG) concentrations in both men and women with epilepsy. Over time, the increase in serum SHBG levels leads to diminished bioactivity of testosterone and estradiol, which may result in diminished potency in men and menstrual disorders in some women, and thus to reduced fertility. Liver enzyme-inducing AEDs also reduce the efficacy of oral contraceptives. Valproic acid medication may have effects on serum androgen concentrations and it reduces serum follicle stimulating hormone levels in men with epilepsy. However, the clinical significance of valproic acid-related reproductive endocrine changes in men is unknown. On the other hand, in women, use of valproic acid appears to be associated with a frequent occurrence of reproductive endocrine disorders characterised by polycystic changes in the ovaries, high serum testosterone concentrations (hyperandrogenism) and menstrual disorders. These disorders are especially common among women who have gained weight during valproic acid treatment. There are some discrepancies regarding the reported occurrence of reproductive endocrine disorders in women taking valproic acid for epilepsy. However, most studies also including patients receiving valproic acid for other reasons than epilepsy, and studies in different non-epileptic animal models, have shown an association between valproic acid medication and hyperandrogenism and related reproductive endocrine disorders. From a practical point of view, the length of the menstrual cycles and bodyweight should be monitored in women with epilepsy after commencement of treatment with valproic acid. A serum testosterone assay is helpful in following the possible biochemical endocrine changes. Ultrasonography of the ovaries (preferably transvaginal) is indicated if clinical assessment and serum testosterone measurement imply that there is a clinically significant valproic acid-related reproductive endocrine problem. That would be the case if the menstrual cycles were irregular or prolonged (usually >35 days) and serum testosterone levels elevated, especially with associated weight gain. The endocrine effects of the new AEDs have not been widely studied. However, it seems they may offer an alternative if reproductive endocrine problems emerge during treatment with the older AEDs.
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Kowatch RA, Fristad M, Birmaher B, Wagner KD, Findling RL, Hellander M. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005; 44:213-35. [PMID: 15725966 DOI: 10.1097/00004583-200503000-00006] [Citation(s) in RCA: 280] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute treatment, and maintenance treatment. These guidelines are not intended to serve as an absolute standard of medical or psychological care but rather to serve as clinically useful guidelines for evaluation and treatment that can be used in the care of children and adolescents with bipolar disorder. These guidelines are subject to change as our evidence base increases and practice patterns evolve.
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Affiliation(s)
- Robert A Kowatch
- Department of Psychiatry, Cincinnati Children's Hospital Medical, OH 45267-0559, USA.
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Kanner AM. Women with epilepsy: can the treatment be worse than the disease? Epilepsy Curr 2005; 5:39-41. [PMID: 16059456 PMCID: PMC1176328 DOI: 10.1111/j.1535-7597.2005.05112.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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