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Epilepsie bei Männern

Einflüsse der Erkrankung und ihrer Behandlung auf reproduktive endokrine Funktionen

Epilepsy in men: The effect of the disease and its therapy on reproductive endocrine functions

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Abstract

In men with epilepsy, the disorder itself as well as its treatment may lead to hormonal changes. Focal seizures and especially temporal lobe epilepsy (TLE) have an impact on the hypothalamic- pituitary axis. Whereas seizures cause a shortlasting increase in serum levels of pituitary hormones, the impact of interictal focal epileptic activity is long lasting. In TLE a decrease of serum levels of free testosterone and the testosterone/luteotrophic hormone ratio is observed, indicating a testicular malfunction. Following successful epilepsy surgery in men with TLE, a significant increase in serum androgen levels is observed within a 12-month follow-up. The supprimation of epileptic acitivity by successful epilepsy surgery is followed by normalization of preoperatively decreased serum concentrations of androgens.

In men with epilepsy an impairment of libido and erectile dysfunction are frequently reported, especially under therapy with enzyme inducing antiepileptic drugs (AEDs). Valproate may lead to a decrease of testicular volumes and increase of androgen serum levels. Carbamazepine as well as valproate may have negative effects on spermatogenesis. In comparison to carbamazepine, phenytoin and phenobarbital, which lead to increased serum levels of sexual hormone binding globulin and decreased levels of the biologically active free testosterone, oxcarbazepine offers advantages and in comparison to valproate other new AEDs like lamotrigine may be an alternative.

Zusammenfassung

Bei Männern mit Epilepsie kann sowohl die Erkrankung selbst als auch ihre Behandlung zu hormonellen Veränderungen führen. Fokale Anfälle, speziell bei einer Temporallappenepilepsie (TLE), beeinflussen die hypothalamisch-hypophysäre Funktionsachse. Während Anfälle einen heftigen, kurzzeitigen Anstieg hypophysärer Hormone induzieren, beeinflusst interiktale epileptische Aktivität die Hormonachse nachhaltiger. Bei TLE kommt es zur Abnahme der Serumkonzentration des freien Testosterons und des Quotienten aus Testosteron und luteotropem Hormon, woraus ein testikulärer Einfluss der Erkrankung abzulesen ist. Eine Supprimierung epileptischer Aktivität durch eine erfolgreiche epilepsiechirurgische Behandlung führt zu einem signifikanten Anstieg der präoperativ verminderten Serumkonzentration von Androgenen.

Bei Männern mit Epilepsie wird eine verminderte Libido und erektile Dysfunktion beobachtet, insbesondere unter Einnahme enzyminduzierender Antiepileptika. Valproat kann zu einer Volumenverminderung der Gonaden und zu einem Androgenanstieg führen. Sowohl Carbamazepin als auch Valproat können die Spermiogenese beeinflussen. Im Vergleich zu Carbamazepin, Phenytoin und Phenobarbital, die zu einem Anstieg des Sexualhormon bindenden Globulins und Abfall des freien, biologisch aktiven Testosterons führen, ist Oxcarbazepin vorteilhafter, und gegenüber Valproat scheinen andere neue Antiepileptika wie z.B. Lamotrigin eine Alternative zu sein.

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Authors and Affiliations

  1. Schweizerisches Epilepsie-Zentrum, Bleulerstr. 60, 8008, Zürich, Switzerland

    Günter Krämer

  2. Universitäts-Klinik für Epileptologie, Bonn, Germany

    Jürgen Bauer

  3. Department Neurologie, Medizinische Universitätsklinik, Innsbruck, Austria

    Gerhard Luef

Authors
  1. Günter Krämer
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  2. Jürgen Bauer
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  3. Gerhard Luef
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Correspondence to Günter Krämer.

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Krämer, G., Bauer, J. & Luef, G. Epilepsie bei Männern. Z. Epileptol. 19, 204–211 (2006). https://doi.org/10.1007/s10309-006-0213-1

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  • DOI: https://doi.org/10.1007/s10309-006-0213-1

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