Psychoneuroendocrine aspects of temporolimbic epilepsy. Part II: Epilepsy and reproductive steroids.

Reproductive dysfunction is unusually common among men and women with epilepsy. Reproductive endocrine disorders are also common and may be causal. The association between particular reproductive endocrine disorders and the laterality and focality of epileptiform discharges suggests an etiologic role for epilepsy. Gonadal steroids are neuroactive and influence seizure occurrence: estrogen is epileptogenic whereas progesterone has antiseizure effects. Fluctuations in the absolute and relative serum levels of these hormones may play a critical role in establishing three distinct patterns of catamenial epilepsy: 1) perimenstrual and 2) preovulatory in women with ovulatory cycles, and 3) entire luteal phase of the cycle in women with anovulatory cycles. Treatment with progesterone reduces seizure frequency by more than half. In men, testosterone effects may depend on the relative concentrations of two major testosterone metabolites that exert opposing influences on neuronal excitability: estrogen potentiates whereas dihydrotestosterone inhibits NMDA-mediated conductance. Combined therapy using an aromatase inhibitor along with testosterone improves sexual function and may reduce seizures in men with epilepsy.