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 Volume 65, Number 7, October 11, 2005
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NEUROLOGY 2005;65:1016-1020
© 2005 American Academy of Neurology

Differential effects of antiepileptic drugs on sexual function and hormones in men with epilepsy

A. G. Herzog, MD, MSc, F. W. Drislane, MD, D. L. Schomer, MD, P. B. Pennell, MD, E. B. Bromfield, MD, B. A. Dworetzky, MD, E. L. Farina, RN and C. A. Frye, PhD

From Harvard Neuroendocrine Unit (Drs. Herzog, Drislane, and Schomer, and E.L. Farina), Beth Israel Deaconess Medical Center, Boston, MA; Neurology Department (Dr. Pennell), Emory University School of Medicine, Atlanta, GA; Department of Neurology (Drs. Bromfield and Dworetzky), Brigham and Women’s Hospital, Boston, MA; and Psychology Department (Dr. Frye), University of Albany-SUNY, Albany, NY.

Address correspondence and reprint requests to Dr. Andrew G. Herzog, Director, Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail: aherzog{at}bidmc.harvard.edu

Objective: To compare sexual function and reproductive hormone levels among men with epilepsy who took various antiepileptic drugs (AEDs), untreated men with epilepsy, and normal controls.

Methods: Subjects were 85 men with localization-related epilepsy (25 on carbamazepine [CBZ], 25 on phenytoin [PHT], 25 on lamotrigine [LTG], and 10 untreated for at least 6 months [no AED]) and 25 controls. Sexual function scores (S-scores), hormone levels (bioactive testosterone, estradiol), hormone ratios (bioactive testosterone/bioactive estradiol), and gonadal efficiency (bioactive testosterone/luteinizing hormone) were compared among the five groups.

Results: S-scores, bioactive testosterone levels, bioactive testosterone/bioactive estradiol, and bioactive testosterone/luteinizing hormone were significantly greater in the control and LTG groups than in the CBZ and PHT groups. Sex hormone binding globulin was significantly higher in the CBZ and PHT groups than in all other groups. S-scores were below the control range in 20% of the men with epilepsy, including 32.0% on CBZ, 24% on PHT, 20% on no AEDs, and 4% on LTG ({chi}2: p = 0.08 for all four groups; {chi}2: p = 0.02 for the three AED groups). Bioactive testosterone was below the control range in 28.2%, including 48% on CBZ, 28% on PHT, 20% on no AEDs, and 12% on LTG ({chi}2: p = 0.02). Among men with epilepsy who had low S-scores, 70.6% had bioactive testosterone levels below the control range as compared to 17.6% among men with normal S-scores ({chi}2: p < 0.0001). Among men with epilepsy who had abnormally low bioactive testosterone, 50.0% had low S-scores; among men with normal bioactive testosterone, 8.2% had low S-scores ({chi}2: p < 0.0001). Bioactive testosterone decline with age was significantly greater among men with epilepsy than among controls and notably greater in the CBZ and PHT groups than in the LTG and untreated groups.

Conclusions: Sexual function, bioavailable testosterone levels, and gonadal efficiency in men with epilepsy who took lamotrigine were comparable to control and untreated values and significantly greater than with carbamazepine or phenytoin treatment.

Editorial, see page 980

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the October 11 issue to find the title link for this article.

Disclosure: This investigation was supported by an investigator-initiated grant from GlaxoSmithKline.

Received April 7, 2005. Accepted in final form June 15, 2005.


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