Seizure threshold, hormones and anti epileptic drugs

Main Article Content

Harsono Harsono

Abstract

The concept of seizure threshold holds that everyone has a certain balance between excitatory and inhibitory forces in the brain. A low seizure threshold makes it easier for epilepsy to develop and easier for someone to elicit single seizure. The opposing effects of estrogen (proconvulsant) and progesterone (anticonvulsant) on seizure threshold have been noted in animal and human studies. Estrogen has been shown to lower the seizure threshold. In contrast to estrogen, several studies have confirmed the anticonvulsive effects of progesterone and its metabolite. Anti-epileptic drugs (AEDs) are used to prevent or interrupt seizures. Limitation of sustained repetitive neuronal firing via blockade of voltage-dependent sodium channels, enhancement of GABA-mediated inhibition, and blockade of glutamatergic excitatory neurotransmission are the mechanisms of anti-epileptic drugs in preventing seizures. AEDs that induce hepatic cytochrome (CY) P450 enzymes can increase the metabolism of sex hormones and make hormonal contraception ineffective. In addition, AEDs may even increase seizure frequency or severity or change the seizure type.

Article Details

How to Cite
Harsono, H. (2008). Seizure threshold, hormones and anti epileptic drugs. Universa Medicina, 27(1), 18–28. https://doi.org/10.18051/UnivMed.2008.v27.18-28
Section
Review Article

References

Fisher R, van Emde Boass W, Blume W, Elger C, Genton P, Lee P, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy and International Bureau for Epilepsy. Epilepsia 2005; 46: 470-2.

Holmes GL, Ben-Ari Y. The neurobiology and consequences of epilepsy in the developing brain. Ped Res 2001; 49: 320-35.

Jackson M. Epilepsy in women. Practical Neurol 2006; 6: 166-79.

Cohen J. New-onset epilepsy in women: an indication for a newer antiepileptic drug? Adv Stud Nurs 2004; 2: 177-82.

Jackson JHA study of convulsions. Transactions of the Saint Andrews Graduate Association 1870; 3: 162–204. Cited by: Holmes GL. Ben-Ari. The neurobiology and consequences of epilepsy in the developing brain. Ped Res 2001; 49: 320-35.

Stafstrom CE. The pathophysiology of epileptic seizures: a primer for pediatricians. Pediatr Rev 1998; 19: 342-51.

Su YH, Izumi T, Kitsu M, Fukuyama Y. Seizure threshold in juvenile myoclonic epilepsy with Graves disease. Epilepsia 1993; 34: 488-92.

Abdelmalik PA, Burnham WM, Carlen PL. Increased seizure susceptibility of the hippocampus compared with the neocortex of the immature mouse brain in vitro. Epilepsia 2005; 46: 356-66.

Penovich PE. The effects of epilepsy and its treatment on sexual and reproductive function. Epilepsia 2000; 41(Suppl. 2): S53-S61.

Harden CL, Baker GA, Frye CA, Montouris GD, Pennell PB, ZupancM. Epilepsy and Ovarian Hormones. Emory University School of Medicine. 2005.

Morrell MJ. Reproductive and metabolic disorders in women with epilepsy. Epilepsia 2003; 44 (Suppl.4): 11-20.

Yerby MS. Neurological management of women with epilepsy. North Pacific Epilepsy Research Center, Oregon 2002.

Morrell MJ. Epilepsy in women. Am Fam Physician 2002; 66: 1489-94.

Hwang JY, Morrell MJ. Coping with epilepsy in women: sexual function, fertility, pregnancy, and bone stability are affected. Women’s Health in Primary Care 1998; 1: 520-7.

Foldvary-Schaefer N, Harden C, Herzog A, Falcone T. Hormones and seizures. Clev Clin J Med 2004; 71(Suppl.2): S11-S8.

Smith SS, Woolley CS. Cellular and molecular effects of steroid hormones on CNS excitability. Clev Clin J Med 2004; 71(Suppl.2): S4-S10.

Reddy DS. Pharmacotherapy of catamenial epilepsy. Indian J Pharmacol 2005; 37: 288-93.

Bauer J, Blumenthal S, Reuber M, Stoffel-Wagner B. Epilepsy syndrome, focus location, and treatment choice affects testicular function in men with epilepsy. Neurology 2004; 62: 243-6.

McQuarrie I, Peeler DB. The effects of sustained pituitary antidiuresis and forced water drinking in epileptic children. A diagnostic and etiologic study. J Clin Invest 1931: 915–40. Cited by Foldvary-Schaefer N, Harden C, Herzog A, Falcone T. Hormones and seizures. Clev Clin J Med 2004; 71(Suppl.2): S11-S8.

Ansell B, Clarke E. Epilepsy and menstruation. The role of water retention. Lancet 1956; 2: 1232-5. Cited by Foldvary-Schaefer N, Harden C, Herzog A, Falcone T. Hormones and seizures. Clev Clin J Med 2004; 71(Suppl.2): S11-S8.

Herzog AG. Psychoneuroendocrine aspects of temporolimbic epilepsy-Part II: Epilepsy and reproductive steroids. Psychosomatics 1999; 40: 102-8.

McAuley JW, Moore JL, Reeves AL, Flyak J, Monaghan EP, Data J. A pilot study of the neurosteroid ganaxolone in catamenial epilepsy: clinical experience in two patients. Epilepsia 2001; 42 (Suppl 7): 85.

Reddy DS. Pharmacology of endogenous neuroactive steroids. Crit Rev Neurobiol 2003; 15: 197-234.

Lambert JJ, Belelli D, Peden DR, Vardy AW, Peters JA. Neurosteroid modulation of GABAA receptors. Progr Neurobiol 2003; 71: 67-80.

Takeuchi Y, Takano T, Abe J, Takikita S, Ohno M. Thyrotropin-releasing hormone: role in the treatment of West syndrome and related epileptic encephalopathies. Brain & Dev 2001; 23: 662-7.

Bittigau P, Sifringer M, Genz K, Reith E, Pospischil D, Govindarajalu S, et al. Antiepileptic drugs and apoptotic neurodegeneration in the developing brain. Proc Natl Acad Sci U S A. 2002; 99: 15089-94.

Edwards HE, MacLusky NJ, Burnham WM. Epileptic seizures: do they cause reproductive dysfunction? Univ Toronto Med J 2000; 77: 104-11.

Herzog AG, Drislane FW, Schomer DL, Pennell PB, Bromfield EB, Dworetzky BA, et al. Differential effects of antiepileptic drugs on sexual function and hormones in men with epilepsy. Neurology 2005; 65: 1016-20.

Isojarvi JIT, Lofgren E, Juntunen KST, Pakarinen AJ, Päivänsalo M, Rautakorpi I, et al. Effect of epilepsy and antiepileptic drugs on male reproductive health. Neurology 2004; 62: 247-53.

Herzog AG, Levesque L, Drislane F, Ronthal M, Neuroendocrine Unit, Charles A. Dana Research Institute, Beth Israel Hospital, and the Department of Neurology, Harvard Medical School, Boston, Massachusetts, U.S.A Schomer DL. Phenytoin-induced elevation of serum estradiol and reproductive dysfunction in men with epilepsy. Epilepsia 1991; 32: 550-3.

Morrell MJ. Health concerns related to anticonvulsant drugs and reproductive and metabolic health. Female Patient Suppl 2004: 2-3.

Rattya J. Reproductive endocrine effects of antiepileptic drugs with special reference to valproate. Dissertation; Oulu; Oulu University Press 2000.

Greewood RS. Adverse effects of antiepileptic drugs. Epilepsia 2000; 41(Suppl. 2): S42-S52.

Berkovic SF. Aggravation of generalized epilepsies. Epilepsia 1998; 39(Suppl. 3): S11-S4.

Elger CE, Bauer J, Schermann J, Widman G. Aggravation of focal epileptic seizures y antiepileptic drugs. Epilepsia 1998; 39(Suppl.3): S15-S8.