Epilepsy versus antiepileptic drugs and gonadal function in men
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This issue of Neurology contains two complementary articles on male reproductive health and epilepsy.1,2⇓ In the first study, Bauer et al.1 focus on the neuroendocrine axis as related to testicular endocrine function. Their analysis of 178 men with focal epilepsy included 117 with temporal lobe epilepsy, 22 with idiopathetic generalized epilepsy, and 33 men not on antiepileptic drugs; 124 of the men were receiving enzyme-inducing antiepileptic drugs. The authors observed a decreased free testosterone in all patient subgroups with epilepsy and found that the free testosterone-to-luteinizing hormone (LH) ratio, a sensitive measure of testicular dysfunction, is also decreased in all groups except for patients with idiopathic generalized epilepsy taking valproic acid. Carbamazepine, especially when compared with valproic acid, decreases total testosterone (T) and increases LH values, resulting in a significantly lower T-to-LH ratio. The authors suggest that, especially for those with temporal lobe …
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