Disorders of reproduction in patients with epilepsy:: Antiepileptic drug related mechanisms
Disorders of reproduction in patients with epilepsy:: Antiepileptic drug related mechanisms
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DOI：
10.1016/j.seizure.2007.11.007
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发表时间：
2008-03-01
影响因子：
3
通讯作者：
Isojarvi, Jouko
中科院分区：
文献类型：
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作者：
Isojarvi, Jouko
癫痫、抗癫痫药物（AEDs）和生殖系统之间存在复杂的相互作用。男性和女性癫痫患者的生育率均低于一般人群。此外，生殖内分泌紊乱在癫痫患者中比在一般人群中更常见。这些疾病已被归因于癫痫本身和AEDs.The使用的肝酶诱导AEDs苯巴比妥，苯妥英钠和卡马西平增加血清性激素结合球蛋白（SHBG）浓度在男性和女性癫痫。随着时间的推移，血清SHBG水平的升高会导致睾酮和雌二醇的生物活性降低，这可能会导致男性的效力降低和一些女性的月经紊乱，从而降低生育能力。丙戊酸盐（VPA）药物可能会影响血清雄激素浓度，并降低男性癫痫患者的血清促卵泡激素水平。然而，VPA相关生殖内分泌变化在男性中的临床意义尚不清楚。另一方面，在女性中，VPA的使用与生殖内分泌疾病的频繁发生相关，其特征为卵巢多囊改变、血清睾酮浓度高（高雄激素血症）和月经紊乱。年轻女性癫痫患者似乎特别容易受到丙戊酸钠对血清雄激素水平的影响，新型抗癫痫药物的内分泌效应尚未得到广泛研究。然而，如果在使用较老的抗癫痫药物治疗期间出现生殖内分泌问题，它们似乎可以提供一种替代方案。另一方面，似乎在许多情况下，如果停止用药，AED的生殖内分泌影响是可逆的。(C)2007年英国癫痫协会。由爱思唯尔有限公司出版。保留所有权利。
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 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.Valproate (VPA) 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 the VPA related reproductive endocrine changes in men is unknown. On the other hand, in women the use of VPA is associated with a frequent occurrence of reproductive endocrine disorders characterized by polycystic changes in the ovaries, high serum testosterone concentrations (hyperandrogenism) and menstrual disorders. Young women with epilepsy seem to be especially vulnerable to the effects of VPA on serum androgen levels.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 antiepileptic drugs. On the other hand, it seems that in many cases the reproductive endocrine effects of the AEDs are reversible, if the medication is discontinued. (C) 2007 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.