Hormone profiles in young adults with epilepsy treated with sodium valproate or lamotrigine monotherapy.
OBJECTIVE
Treatment with sodium valproate (VPA) may be associated with polycystic ovarian syndrome (PCOS) in some women with epilepsy. By comparing hormone profiles in young adults taking VPA or lamotrigine (LTG) as monotherapy, this study aimed to explore whether a pharmacologic effect of VPA could be responsible for this observation.


METHODS
Hormone profiles in men and women taking VPA (n = 40) or LTG (n = 36) monotherapy for epilepsy were compared. None of the women were receiving hormonal contraception or replacement. Patients gave details of seizure type and frequency, menstrual cycle, and medical and drug history. Body mass index was calculated, and fasting insulin, glucose, cholesterol, triglycerides (TG), high- and low-density lipoproteins, testosterone, dihydroepiandosterone (DHEA), androstenedione, sex hormone-binding globulin (SHBG), free androgen index (FAI), luteinising hormone (LH), follicle-stimulating hormone (FSH), and antiepileptic drug (AED) concentrations were measured.


RESULTS
There were no differences between treatment groups for both sexes in age and seizure control. Only four obese VPA-treated women were hyperinsulinaemic (p = 0.05); three with abnormal menstrual cycles; one with raised testosterone. Testosterone (p = 0.02), FAI (p = 0.03), and TG (p = 0.02) levels were higher, however, in women taking the drug. Obese patients of both sexes (p = 0.01) and VPA-treated men (p = 0.03) had higher insulin concentrations.


CONCLUSIONS
VPA therapy may be associated with subclinical elevation in fasting insulin levels. Testosterone and TG levels were higher in VPA-treated women compared with the levels in those taking LTG. However, only a minority of obese females exhibited biochemical characteristics suggestive of PCOS. Biochemical screening may allow women at risk of developing PCOS to avoid VPA.
Stephen
L J
LJ
Epilepsy Unit, University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, Scotland, UK.
Kwan
P
P
Shapiro
D
D
Dominiczak
M
M
Brodie
M J
MJ
D000328:Adult; D000927:Anticonvulsants / Q000592:standards* / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D015897:Comorbidity; D003687:Dehydroepiandrosterone / Q000097:blood; D004827:Epilepsy / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000453:epidemiology; D007328:Insulin / Q000097:blood*; D000077213:Lamotrigine; D008055:Lipids / Q000097:blood; D008297:Male; D008599:Menstruation Disturbances / Q000097:blood / Q000453:epidemiology; D009765:Obesity / Q000097:blood / Q000453:epidemiology; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D012737:Sex Factors; D013739:Testosterone / Q000097:blood*; D014227:Triazines / Q000009:adverse effects / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use*
D000927:Anticonvulsants; D001786:Blood Glucose; D007328:Insulin; D008055:Lipids; D014227:Triazines; D014280:Triglycerides; D013739:Testosterone; D003687:Dehydroepiandrosterone; D014635:Valproic Acid; D000077213:Lamotrigine