Differential effects of antiepileptic drugs on sexual function and reproductive hormones in men with epilepsy: interim analysis of a comparison between lamotrigine and enzyme-inducing antiepileptic drugs.
OBJECTIVE
We compared sexual function and reproductive hormone levels among men with localization-related epilepsy (LRE) taking various antiepileptic drugs (AEDs) and normal controls (NC).


METHODS
Subjects were 63 men with LRE [enzyme-inducing (EI) AEDs, 36; lamotrigine (LTG), 18; no AEDs, 9] and 18 NC. Sexual interest and function (S-score), hormone levels [bioactive testosterone (BAT) and estradiol (BAE)], hormone ratios [BAT/BAE], and gonadal efficiency [BAT/luteinizing hormone (LH)] were compared among the groups.


RESULTS
S-scores, BAT levels, BAT/BAE, and BAT/LH were significantly lower in the EIAED group than in NC or LTG groups. Sex hormone-binding globulin (SHBG) was significantly higher in the EIAED group than in all other groups. Of men with LRE, 23.8% had abnormally low S-scores: 33.3% taking EIAEDs, 5.5% taking LTG, and 22.2% taking no AEDs (p < 0.01). BAT was low in 55.6% taking EIAEDs as compared with 33.3% taking LTG and 33.3% taking no AEDs (p < 0.05). Among men with low S-scores, 86.7% had low BAT as compared with 33.3% of men with normal scores (p < 0.01). BAT decline with age was greater among men with LRE than in controls (3.75 vs. 1.80 ng/dl/yr). The slope showed no significant difference among LRE groups. However, 89% of 40- to 50-year-old men taking EIAEDs had low BAT as compared with 33% taking LTG and 33% taking no AED (p < 0.01).


CONCLUSIONS
Sexual function, BAT levels, BAT/BAE, and gonadal efficiency are greater with LTG than with EIAED. Abnormally low BAT levels are reached at an earlier age with EIAEDs than with LTG.
Herzog
Andrew G
AG
Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. aherzog@bidmc.harvard.edu
Drislane
Frank W
FW
Schomer
Donald L
DL
Pennell
Page B
PB
Bromfield
Edward B
EB
Kelly
Kevin M
KM
Farina
Erin L
EL
Frye
Cheryl A
CA
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use; D002220:Carbamazepine / Q000494:pharmacology / Q000627:therapeutic use; D004828:Epilepsies, Partial / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D004958:Estradiol / Q000097:blood; D006801:Humans; D000077213:Lamotrigine; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000494:pharmacology / Q000627:therapeutic use; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D012725:Sexual Behavior / Q000187:drug effects* / Q000502:physiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood*; D014227:Triazines / Q000494:pharmacology* / Q000627:therapeutic use
D000927:Anticonvulsants; D012738:Sex Hormone-Binding Globulin; D014227:Triazines; D002220:Carbamazepine; D013739:Testosterone; D004958:Estradiol; D010672:Phenytoin; D007986:Luteinizing Hormone; D000077213:Lamotrigine