Einflüsse der Epilepsieerkrankung auf reproduktive endokrine Funktionen bei Männern

Zusammenfassung

Fokale Epilepsien nehmen Einfluss auf die hypothalamisch-hypophysäre Funktionsachse. Anfälle induzieren einen heftigen, kurzzeitigen Anstieg hypophysärer Hormone. Interiktale epileptische Aktivität hingegen beeinflusst die Hormonachse nachhaltiger. Insbesondere Epilepsien temporalen Ursprungs (TLE) mindern die Serumkonzentration des freien Testosteron und des Quotienten aus Testosteron und luteotropem Hormon, woraus ein testikulärer Einfluss der Erkrankung abzulesen ist. Erst die erfolgreiche Supprimierung interiktaler epileptischer Aktivität durch eine epilepsiechirurgische Behandlung von TLE führt innerhalb des ersten postoperativen Jahres zu einem signifikanten Anstieg der präoperativ verminderten Serumkonzentration von Androgenen. Der Einfluss fokaler Epilepsien auf endokrine Funktionen unterstreicht, dass Epilepsien Erkrankungen sind, die nicht nur mit der Manifestation epileptischer Anfälle einhergehen.

Abstract

Focal epilepsies have impact on the hypothalamic-pituitary axis. Seizures cause a short-lasting increase in serum levels of pituitary hormones. However, the impact of interictal focal epileptic activity is long-lasting. Especially in men with temporal lobe epilepsy (TLE) serum levels of free testosterone and the testosterone/luteotrophic hormone ratio is decreased, indicating a testicular malfunction. Following a successful epilepsy surgery in men with TLE a significant increase in serum androgen levels is observed within a 12 month follow-up. The endocrine effects of focal epilepsies are an example to underline that the symptomatology of epilepsy is not limited to the manifestation of seizures.

Literatur

• 1 Weinbauer G F, Gromoll J, Simoni M. et al . Physiologie der Hodenfunktion. In: Nieschlag E, Behre HM (Hrsg) Andrologie. Heidelberg; Springer 2000: 27-90
• 2 Bauer J, Stefan H, Schrell U. et al . Serum prolactin concentrations and epilepsy: a study comparing patients in presurgical evaluation with healthy persons and circadian with seizure related variations.  Eur Arch Psychiatry Clin Neurosci. 1992;  241 365-371
• 3 Bauer J. Epilepsy and prolactin in adults: a clinical review.  Epilepsy Res. 1996;  24 1-7
• 4 Oribe E, Amini R, Nissenbaum E. et al . Serum prolactin concentrations are elevated after syncope.  Neurology. 1996;  47 60-62
• 5 Cordingly G, Brown D, Dane P. et al . Increases in serum prolactin levels associated with syncopal attacks.  Am J Energ Med. 1993;  11 251-252
• 6 Alving J. Serum prolactin leves are elevated also after pseudo-epileptic seizures.  Seizure. 1998;  7 85-89
• 7 Rao M L, Stefan H, Bauer J. Epileptic but not psychogenic seizures are accompanied by simultaneous elevation of serum pituitary hormones and cortisol levels.  Neuroendocrinology. 1989;  49 33-39
• 8 Bauer J, Stefan H, Schrell U. et al . Neurophysiologische Grundlagen und klinische Wertigkeit der postiktualen Serum-Prolaktinbestimmung bei epileptischen Anfällen.  Fortschr Neurol Psychiat. 1989;  57 457-468
• 9 Renaud L P. An electrophysiological study on amygdala-hypothalamic projections to the ventromedial nucleus of the rat.  Brain Res. 1976;  105 45-48
• 10 Witter M P, Groenewegen H J, Lopes da Silvia F H. et al . Functional organization of the extrinsic and intrinsic circuity of the parahippocampal region.  Progr Neurobiol. 1989;  33 161-253
• 11 Bilo L, Meo R, Striano S. Serum prolactin evaluation after „minor” generalised seizures monitored by EEG.  J Neurol Neurosurg Psychiatry. 1988;  51 308-309
• 12 Sassin J F, Frantz A G, Weitzman E D. et al . Human prolactin 24 hours pattern with increased release during sleep.  Science. 1972;  177 1205-1207
• 13 Bauer J, Landgraf S, Schrell U. et al . Anstieg der Serum-Prolactinkonzentration nach Frontallappenanfällen. Möglichkeit zur Differenzialdiagnose psychogener Anfälle.  DMW. 1991;  116 1824-1827
• 14 Bauer J, Kaufmann P, Elger C E. et al . Similar postictal serum prolactin response in complex partial seizures of temporal or frontal lobe onset.  Arch Neurol. 1994;  51 645
• 15 Williamson P D, Spencer S S. Clinical and EEG features of complex partial seizures of extratemporal origin.  Epilepsia. 1986;  27, Suppl 2 46-63
• 16 Bauer J, Rao M L, Stefan H. Postiktuale Serum-Prolaktin-Bestimmung zur Differenzierung zwischen epileptischen und psychogenen Anfällen.  Aktuel Neurol. 1987;  14 60-62
• 17 Bauer J, Kaufmann P, Klingmüller D. et al . Serum prolactin response to repetitive epileptic seizures.  J Neurol. 1994;  241 242-245
• 18 Bauer J, Uhlig B, Schrell U. et al . Exhaustion of postictal serum prolactin release during status epilepticus.  J Neurol. 1992;  239 175-176
• 19 Lindbom U, Tomson T, Nilsson B Y. et al . Serum prolactin response to thyrotropin-releasing hormone during status epilepticus.  Seizure. 1993;  2 235-239
• 20 Lindbom U, Tomson T, Nilsson B Y. et al . Serum prolactin response to metoclopramide during status epilepticus.  J Neurol Neurosurg Psychiatry. 1992;  55 685-687
• 21 Franceschi M, Perego L, Cavagnini F. et al . Effect of long-term antiepileptic therapy on the hypothalamic-pituitary axis in man.  Epilepsia. 1984;  25 46-52
• 22 MacPhee G JA, Larkin J G, Butler E. et al . Circulating hormones and pituitary responsiveness in young epileptic men receiving long-term antiepileptic medication.  Epilepsia. 1988;  29 468-475
• 23 Stoffel-Wagner B, Bauer J, Flügel D. et al . Serum sex-hormones are altered in patients with chronic focal epilepsies treated with anticonvulsant drugs.  Epilepsia. 1998;  39 1164-1173
• 24 Molaie M, Culebras A, Miller M. Nocturnal plasma prolactin rise in patients with complex partial seizures.  Ann Neurol. 1985;  18 719-722
• 25 Molaie M, Culebras A, Miller M. Effect of interictal epileptiform discharges on nocturnal plasma prolactin concentrations in epileptic patients with complex partial seizures.  Epilepsia. 1986;  27 724-728
• 26 Molaie M, Culebras A, Miller M. Nocturnal plasma prolactin and cortisol levels in epileptics with complex partial seizures.  Arch Neurol. 1987;  44 699-702
• 27 Bauer J, Blumenthal S, Reuber M. et al . Epilepsy syndrome, focus location, and treatment choice affect testicular function in men with epilepsy.  Neurology. 2004;  62 243-246
• 28 Quigg M, Kiely J M, Shneker B. et al . Interictal and postictal alterations of pulsatile secretion of luteinizing hormone in temporal lobe epilepsy in men.  Ann Neurol. 2002;  51 559-566
• 29 Bauer J, Stoffel-Wagner B, Flügel D. et al . Serum androgens return to normal following temporal lobe epilepsy surgery in men.  Neurology. 2000;  55 820-824
• 30 Bauer J, Rösing B, Klingmüller D. Wozu Endokrinologie in der Epileptologie?. Nürnberg; Novartis Pharma Verlag 2002
• 31 Bauer J, Isojärvi J IT, Herzog A G. et al . Reproductive dysfunction in women with epilepsy: Recommendations for evaluation and management.  J Neurol Neurosurg Psychiatry. 2002;  73 121-125
• 32 Herzog A G, Coleman A E, Jacobs A R. et al . Interictal EEG discharges, reproductive hormones, and menstrual disorders in epilepsy.  Ann Neurol. 2003;  54 625-637
• 33 Bauer J. Epilepsy therapy: issues in women and men.  Curr Opinon Neurol. 2001;  14 199-202
• 34 Isojärvi J IT, Löfgren E, Juntunen K ST. et al . Effect of epilepsy and antiepileptic drugs on male reproductive health.  Neurology. 2004;  62 247-253
• 35 Herzog A G. Altered reproductive endocrine regulation in men with epilepsy: implications for reproductive function and seizures.  Ann Neurol. 2002;  51 539-542
• 36 Herzog A G, Seibel M M, Schomer D L. et al . Reproductive endocrine disorders in men with partial seizures of temporal lobe origin.  Arch Neurol. 1986;  43 347-350
• 37 Herzog A G. Disorders of reproduction and fertility. In: Engel J, Pedley TA (eds) Epilepsy: A Comprehensive Textbook. Philadelphia; Lippincott-Raven 1997: 2013-2019
• 38 Lambert M V. Seizures, hormones and sexuality.  Seizure. 2001;  10 319-340
• 39 Toone B K, Wheeler M, Nanjee M. et al . Sex hormones, sexual activity and plasma anticonvulsant levels in male epileptics.  J Neurol Neurosurg Psychiatry. 1983;  46 824-826
• 40 Fenwick P B, Mercer S, Grant R. et al . Nocturnal penile tumescence and serum testosterone levels.  Arch Sex Behav. 1986;  15 13-21
• 41 Isojärvi J IT, Pakarinen A J, Ylipalosaari P J. et al . Serum hormones in male epileptic patients receiving anticonvulsant medication.  Arch Neurol. 1990;  47 670-676
• 42 Herzog A G, Drislane F W, Schomer D L. et al . Abnormal pulsatile secretion of luteinizing hormone in men with epilepsy: relationship to laterality and nature of paroxysmal discharges.  Neurology. 1990;  40 1557-1561
• 43 Murialdo G, Galimberti C A, Fonzi S. et al . Sex hormones and pituitary function in male epileptic patients with altered or normal sexuality.  Epilepsia. 1995;  36 360-365
• 44 Husain A M, Carwile S T, Miller P P. et al . Sexual dysfunction in male veterans with epilepsy.  J Epilepsy. 1998;  11 144-147
• 45 Taylor D C. Sexual behaviour and temporal lobe epilepsy.  Arch Neurol. 1969;  21 510-516
• 46 Toone B K, Edeh J, Nanjee M. et al . Hyposexuality and epilepsy: a community survey of hormonal and behavioural changes in male epileptics.  Psychol Med. 1989;  19 937-943
• 47 Spector I P, Carey M P. Incidence and prevalence of the sexual dysfunctions: a critical review of the empirical literature.  Arch Sex Behav. 1990;  19 389-408
• 48 Hierons R, Saunders M. Impotence in patients with temporal lobe lesions.  Lancet. 1996;  2 761-764
• 49 Saunders M, Rawson M. Sexuality in male epileptics.  J Neurol. 1970;  10 577-583
• 50 Blumer D, Walker A. Sexual behavior in temporal lobe epilepsy.  Arch Neurol. 1967;  16 31-43