HYPOTHALAMIC-PITUITARY-OVARIAN AXIS IN WOMEN WITH EPILEPSY

患有癫痫的女性可能面临生殖健康功能障碍的风险， 包括月经不调、无排卵、多囊卵巢 综合征，以及基础释放和脉动性释放障碍 促性腺激素和卵巢类固醇。这项研究将定义生殖 女性癫痫患者的健康风险及其相关因素的确定 癫痫综合征、癫痫发作频率和癫痫发作的机制 以及单一疗法中使用的个别抗癫痫药物(AEDs)。 垂体和性腺激素、排卵功能和卵巢 形态和黄体期功能/充分性将在 患有以下三种不同癫痫综合征之一的女性：(1)特发性 原发性全身性癫痫，其中大脑皮层 结构和功能正常；(2)症状、定位 起源于颞叶的相关性癫痫(LRE)，其中有一个 颞叶结构和/或功能损害；和(3) 起源于颞外叶的LRE，致痫区域 位于颞叶之外。这些生殖指标 功能也将根据暴露于AEDs在 诱导、抑制或不改变肝脏的单一疗法 混合功能细胞色素P450酶系统。 患有颞叶LRE的女性被假设为 优先处于生殖健康功能障碍的风险中，因为， 考虑到内侧颞叶的广泛输入 丘脑下部、颞叶致痫灶有可能引起 下丘脑-垂体轴功能障碍。有癫痫发作的女性涉及 颞叶也有危险，因为这些癫痫发作与 脑下垂体激素异常。此外，AEDs抑制了 P450会增加类固醇激素浓度，可能会导致 生殖功能障碍。颞叶癫痫与癫痫的对比研究 AEDs将通过评估生殖功能进一步区分 女性在手术切除颞叶前后的情况 致痫灶，之后癫痫发作可能会缓解，而AEDs 保持不变。这些发现将允许临床医生选择 最不可能损害生殖健康的AED 考虑到癫痫综合症，这将使患有癫痫的女性更有可能 癫痫和生殖功能障碍被识别并适当地 治疗过了。

Women with epilepsy may be at risk for reproductive health dysfunctions, including menstrual irregularity, anovulation, polycystic ovarian syndrome, and disturbances in basal and pulsatile release of gonadotropins and ovarian steroids. This study will define reproductive health risks for women with epilepsy and determine the relative mechanistic contribution of epilepsy syndrome, seizure frequency and type, and of individual antiepileptic drugs (AEDs) used in monotherapy. Pituitary and gonodal hormones, ovulatory function and ovarian morphology, and luteal phase function/adequacy will be evaluated in women with one of three distinct epilepsy syndromes: (1) idiopathic primary generalized epilepsy, in which the cerebral cortex is structurally and functionally normal; (2) symptomatic, localization related epilepsy (LRE) of temporal lobe origin, in which there is a strucutural and/or functional lesion within the temporal lobe; and (3) LRE of extratemporal lobe origin in which the epileptogenic region resides outside of the temporal lobe. These indices of reproductive function will also be evaluated according to exposure to AEDs in monotherapy that either induce, inhibit, or do not alter the hepatic mixed-function cytochrome P 450 enzyme system. Women with LRE of temporal lobe origin are hypothesized to be preferentially at risk for reproductive health dysfunctions because, given the extensive input of the mesial temporal lobe to the hypothalamus, the temporal lobe epileptogenic lesion is likely to cause hypothalamic-pituitary axis dysfunction. Women with seizures involving the temporal lobe are also at risk since these seizures are associated with pituitary hormone abnormalities. In addition, AEDs which inhibit P450 will increase steroid hormone concentrations and may predispose to reproductive dysfunctions. The effects of temporal lobe epilepsy versus AEDs will be further differentiated by evaluating reproductive function in women before and after surgical resection of a temporal lobe epileptogenic focus, after which seizures are likely to remit while AEDs are held constant. These findings will permit the clinician to select an AED which is least likely to compromise reproductive health for a given epilepsy syndrome, and will make it more likely that women with epilepsy and reproductive dysfunction are identified and appropriately treated.