levetiracetam and Erectile-Dysfunction

The effects of the antiepileptic drugs sodium valproate (VPA) and levetiracetam (LEV) on reproductive endocrine function, sexual function, and spermatozoa were explored, together with their possible etiological mechanisms, in Chinese Han men with epilepsy. Following VPA treatment (n=32), luteinizing hormone and follicle-stimulating hormone levels were significantly lower than in controls (n=30). The bioactive testosterone/luteinizing hormone ratio and the prolactin level were significantly elevated in the VPA treatment group. There were no significant differences in these hormones between the LEV treatment (n=20) and control groups. The rates of sperm morphologic abnormality (head, body, and tail) were significantly higher in the VPA treatment group than the control group but did not differ significantly between the LEV treatment and control groups. The sperm motility rate was significantly lower in the VPA treatment group (grade A sperm motility rate <25%, grade A+B sperm motility rate <50%) than in controls, as well as in the LEV treatment group (grade A sperm motility rate <25%). Patients in the VPA and LEV treatment groups had lower scores on questions 1, 2 and 3 of a simplified International Index of Erectile Function Scale than controls, but no significant difference on questions 4 or 5. The total International Index of Erectile Function Scale scores were significantly lower in the VPA and LEV treatment groups. We conclude that treatment with VPA adversely affects reproductive endocrine function, sperm parameters and sexual function to varying degrees in Chinese men with epilepsy.

Topics: Adolescent; Adult; Anticonvulsants; Asian People; Epilepsy; Erectile Dysfunction; Follicle Stimulating Hormone; Humans; Infertility, Male; Levetiracetam; Luteinizing Hormone; Male; Middle Aged; Piracetam; Spermatozoa; Testosterone; Valproic Acid; Young Adult

The relationship between the older antiepileptic drugs (AEDs) and sexual dysfunction has long been known and it is likely to be related to sexual hormonal changes. Instead, rare reports on sexual disorders related to new AEDs suggest the possibility of complex and poorly understood mechanisms, mainly involving central nervous system neurotransmitters such as glutamate, serotonin, and dopamine. Herein, we describe two young men with epilepsy who experienced severe loss of libido and anhedonia after levetiracetam intake.

Topics: Adult; Anhedonia; Anticonvulsants; Brain; Electroencephalography; Epilepsies, Myoclonic; Epilepsy, Complex Partial; Erectile Dysfunction; Gonadal Steroid Hormones; Humans; Lamotrigine; Levetiracetam; Libido; Magnetic Resonance Imaging; Male; Piracetam; Triazines; Valproic Acid; Young Adult

The effect of testosterone on brain excitability is unclear. The excitatory aspect of testosterone's action in the brain may be due to its conversion to estrogen via aromatase. We report herein a 61-year-old man with temporal lobe epilepsy and sexual dysfunction due to low testosterone levels. Use of an aromatase inhibitor, letrozole, normalized his testosterone level and improved his sexual functioning. Letrozole, in addition to standard antiseizure medication, was also associated with improved seizure control. This was sustained and, further, was associated with seizure exacerbation after withdrawing letrozole, and subsequent seizure improvement after restarting it. During the course of treatment, his serum testosterone level increased, sex hormone-binding globulin decreased (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels increased, while serum estradiol levels remained undetectable. Letrozole may, therefore, have produced a central alteration in the testosterone/estrogen ratio, thereby impairing estrogen-mediated feedback control of the pituitary, resulting in the observed increase in circulating LH and FSH levels. This experience suggests that aromatase inhibitors should be further investigated as a beneficial treatment modality for male patients with epilepsy.

Topics: Anticonvulsants; Aromatase Inhibitors; Dose-Response Relationship, Drug; Drug Therapy, Combination; Electroencephalography; Epilepsy, Temporal Lobe; Erectile Dysfunction; Estradiol; Follicle Stimulating Hormone; Humans; Letrozole; Levetiracetam; Libido; Luteinizing Hormone; Male; Middle Aged; Nitriles; Piracetam; Quality of Life; Sex Hormone-Binding Globulin; Testosterone; Triazoles