Reproductive dysfunction in women with epilepsy:: recommendations for evaluation and management
Reproductive dysfunction in women with epilepsy:: recommendations for evaluation and management
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DOI：
10.1136/jnnp.73.2.121
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发表时间：
2002-08-01
影响因子：
11
通讯作者：
Elger, CE
中科院分区：
文献类型：
--
作者：
Bauer, J;Isoj채rvi, JIT;Elger, CE
背景：癫痫通常与生殖内分泌紊乱有关。这些包括多囊卵巢综合征（PCOS），孤立的组成部分，这种综合征，如多囊卵巢，高雄激素血症，下丘脑性闭经，和功能性高催乳素aemia.Objective：To summarise the currently known relationships between epilepsy and reproductive endocrine disorders.Methods：A review of clinical experience and published reports.Results：The most likely explanation for endocrine disorders related to epilepsy or antiepilepsy drugs are：（1）致痫性病变、癫痫或抗癫痫药物对大脑内分泌控制中心的直接影响;（2）抗癫痫药物对外周内分泌腺的影响;（3）抗癫痫药物对激素和结合蛋白代谢的影响;（4）抗癫痫药物相关的体重变化或胰岛素敏感性变化的继发性内分泌并发症。建议在访视时定期监测生殖功能，包括询问月经紊乱、生育能力、体重、多毛症和溢乳症。应特别注意丙戊酸盐治疗患者和肥胖患者或体重显著增加的患者。没有症状的单一异常实验室或影像学检查结果可能不构成临床相关的内分泌疾病。然而，这些类型的异常的患者应进行监测，以检测可能的发展与症状性疾病，例如，月经失调或生育问题。结论：如果发现生殖内分泌失调，抗癫痫药物治疗应进行审查，以确保它是正确的特定癫痫发作类型，它是不是有助于内分泌问题。改变治疗的可能益处必须与癫痫控制和替代药物的累积副作用相平衡。
Background: Epilepsy is commonly associated with reproductive endocrine disorders. These include polycystic ovary syndrome (PCOS), isolated components of this syndrome such as polycystic ovaries, hyperandrogenaemia, hypothalamic amenorrhoea, and functional hyperprolactinaemia.Objective: To summarise the currently known relations between epilepsy and reproductive endocrine disorders.Methods: A review of clinical experience and published reports.Results: The most likely explanations for endocrine disorders related to epilepsy or antiepileptic drugs are: (1) a direct influence of the epileptogenic lesion, epilepsy, or antiepileptic drugs on the endocrine control centres in the brain; (2) the effects of antiepileptic drugs on peripheral endocrine glands; (3) the effects of antiepileptic drugs on the metabolism of hormones and binding proteins; and (4) secondary endocrine complications of antiepileptic drug related weight changes or changes of insulin sensitivity. Regular monitoring of reproductive function at visits is recommended, including questioning about, menstrual disorders, fertility, weight, hirsutism, and galactorrhoea. Particular attention should be paid to patients on valproate and obese patients or those experiencing significant weight gain. Single abnormal laboratory or imaging findings without symptoms may not constitute a clinically relevant endocrine disorder. However, patients with these kinds of abnormalities should be monitored to detect the possible development of a symptomatic disorder associated with, for example, menstrual disorders or fertility problems.Conclusions: If a reproductive endocrine disorder is found, antiepileptic drug treatment should be reviewed to ensure that it is correct for the particular seizure type and that it is not contributing to the endocrine problem. The possible benefits of a change in treatment must be balanced against seizure control and the cumulative side effect of alternative agents.