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my personal edition > epilepsy > news
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DGReview
Generalized Epilepsy And Use Of Valproate Linked To Reproductive Dysfunction
A DGReview of :"Predictors of ovulatory failure in women with epilepsy"
Annals of Neurology
12/19/2002
By Alison Palkhivala
Women with epilepsy are at increased risk of experiencing reproductive dysfunction, particularly if they have idiopathic generalized epilepsy and have a recent history of valproate use.
In a study led by Martha J. Morrell, MD, from the Columbia University department of neurology, New York, New York, United States, 94 women aged 18 to 40 with epilepsy were compared with 23 women without epilepsy with respect to their ovulatory cycles. The women with epilepsy included 59 patients with localization-related epilepsy and 35 patients with idiopathic (primary) generalized epilepsy. All were taking a single antiepileptic drug for at least six months that induced, inhibited or had no effect on the cytochrome P450 enzyme.
The women were followed for three menstrual cycles. All underwent transvaginal ultrasounds and endocrine and metabolic variable measurement. Luteinizing hormone was sampled in all patients over eight hours on days 2 and 5 of one cycle.
Overall, anovulatory cycles occurred in 10.9 percent of cycles in controls compared with 14.3 percent of women with localization-related epilepsy and 27.1 percent of women with idiopathic generalized epilepsy. Notably, 38.1 percent of women who were using valproate currently or within the previous three years had at least one anovulatory cycle, compared with only 10.7 percent of those who did not have this history of valproate use.
Predictors of ovulatory failure included the presence of idiopathic generalized epilepsy, history of use of valproate currently or in the previous three years, high free testosterone levels and fewer numbers of luteinizing hormone pulses. The presence of polycystic-appearing ovaries did not predict ovulatory failure.
According to the authors, women with epilepsy are more likely to experience anovulatory menstrual cycles, and the use of antiepileptic therapies may add to the problem. In particular, women with idiopathic generalized epilepsy and those taking valproate were at highest risk of ovulatory failure, polycystic-appearing ovaries, elevated body mass index and hyperandrogynism. Since women with epilepsy may have no other outward signs of reproductive dysfunction, clinicians must keep this association in mind.
Annals of Neurology 2002; 52:6:704-711.
"Predictors of ovulatory failure in women with epilepsy"
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