Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2013 Jan;12(1):72-83.
doi: 10.1016/S1474-4422(12)70239-9.

Neuroendocrine considerations in the treatment of men and women with epilepsy

Cynthia L Harden  1 , Page B Pennell
Affiliations
Review

Neuroendocrine considerations in the treatment of men and women with epilepsy

Cynthia L Harden et al. Lancet Neurol. 2013 Jan.

Erratum in

  • Lancet Neurol. 2013 Feb;12(2):128. Dosage error in article text

Abstract

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

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

PBP declares that she has no conflicts of interest.

Figures

Figure 1
Figure 1. Hypothalamic-pituitary-gonadal axis in women and men
Hormones relevant to the scope of this Review are shown for women (A) and men (B). FSH=follicle-stimulating hormone. LH=luteinising hormone. GnRH=gonadotropin-releasing hormone.
Figure 2
Figure 2. Patterns of catamenial epilepsy
Day 1 is the first day of menstrual flow and day –14 is the day of ovulation. (A) Normal cycle with normal ovulation. C1 pattern is associated with exacerbation of seizures in the perimenstrual phase, and C2 pattern is associated with exacerbation of seizures in the periovulatory phase. (B) Inadequate luteal phase cycle with anovulation. The C3 pattern is associated with exacerbations beginning day 10 of one cycle through day 3 of the next cycle. C=catamenial seizure pattern. F=follicular phase. O=periovulatory. L=luteal phase. M=perimenstrual. Modified and reproduced from Herzog and colleagues, by permission of Blackwell Publishing.
Figure 3
Figure 3. Treatment algorithm for catamenial C1 pattern of seizures
Most treatments are for focal-onset seizures in women with regular menses. C1 level 3=three times more seizures on days 25–3 compared with other days of the month. AEDs=antiepileptic drugs. PHT=phenytoin. IM=intramuscularly. *If menses start before day 26, start dose tapering on that day according to the same pattern of decreases. †Widely undertaken but not supported by data from randomised, controlled trials. ‡Increased risk of osteoporosis and slow return to normal fertility.
See this image and copyright information in PMC

References

    1. Chen DK, So YT, Fisher RS. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65:668–675. - PubMed
    1. Mytinger JR, Joshi S. The current evaluation and treatment of infantile spasms among members of the Child Neurology Society. J Child Neurol. 2012;27:1289–1294. - PubMed
    1. Pack M, Reddy DS, Duncan S, Herzog A. Neuroendocrinological aspects of epilepsy: important issues and trends in future research. Epilepsy Behav. 2011;22:94–102. - PubMed
    1. Finocchi C, Ferrari M. Female reproductive steroids and neuronal excitability. Neurol Sci. 2011;32(suppl 1):S31–S35. - PubMed
    1. Frye CA. Effects and mechanisms of progestogens and androgens in ictal activity. Epilepsia. 2010;51(suppl 3):135–140. - PubMed

Publication types