EPILEPTIFORM DISCHARGE LATERALITY AND HORMONAL SECRETION

描述（研究者摘要）：大脑控制生殖

DESCRIPTION (Investigator's Abstract): The brain controls reproductive function primarily through the hypothalamic regulation of pituitary secretion (1). Regions of the hypothalamus which regulate and produce gonadotropin releasing hormone receive extensive direct connections from temporolimbic structures, especially from the amygdala (1). Cerebral influences on the hypothalamopituitary his, however, have received little systematic clinical inquiry. Temporal lobe epilepsy (TLE), the most common form of epilepsy in adults, generally originates in, or at least involves, temporolimbic structures such as the amygdala (1). Medial temporal lobe ictal discharges commonly produce transient hormonal changes (1). The frequent occurrence of chronic reproductive endocrine disorders-and reproductive dysfunction among men and women with epilepsy, in particular those with TLE, raises the consideration that frequent or persistent interictal epileptiform disruption of temporolimbic activity may lead to chronically altered hypothalamopituitary regulation of gonadal secretion and promote the development of reproductive endocrine disorders (1). The observation in women that left-sided TLE is associated with polycystic ovarian syndrome (PCO) and right-sided TLE is associated with hypothalamic amenorrhea (hypogonadotropic hypogonadism, HH) , moreover, suggests a lateralized asyrnmetry in this effect (1). TLE, therefore, may serve as a model to assess the role of temporolimbic structures in the cerebral modulation of hormonal secretion and reproductive function, as well as the role that cerebral dysfunction may have in the pathophysiology of certain common reproductive endocrine disorders, such as polycystic ovarian syndrome and hypothalamic amenorrhea, which are over represented in TLE but have generally been assumed to be of primary hypothalamic origin. This investigation will sample blood every 10 minutes and record continuous EEG over 8 hours in men and women with unilateral TLE in order to determine if serum levels and ultradian patterns of gonadotropin and prolactin secretion 1) differ between individuals with TLE and normal controls, 2) in relation to the laterality of temporal lobe interictal epileptiform EEG discharges and 3) are consistent with the development of those particular reproductive endocrine disorders that are known to be associated with left and right TLE.