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09 June 2016

Discussing the impact of epilepsy on sexual function

Doctors should be pro-active in discussing the impact of epilepsy on sexual function and gender-related issues, said Gerhard Luef at the 2nd congress of the European Academy of Neurology in Copenhagen.

People with epilepsy tend to be reluctant to discuss sexual health problems during their neurology appointment and will instead seek medical advice from other healthcare professionals who may not have the knowledge to recognise and deal with the problem.

'Women who are having problems related to sex may seek the advice of their gynaecologist. But the gynaecologist may not have knowledge about, for example, temporal lobe epilepsy or the relationship between anti-epileptic drugs and hormone levels,' said Dr Luef of the Medical University Innsbruck, Austria.

'Men will say nothing. It is only when we put flyers in the waiting room that patients pick them up and bring them into their appointment. Then we know to start a conversation.'

Epidemiological studies show little difference in the incidence of epilepsy in men and women, but there are significant differences in the impact on the two different sexes, Dr Luef told delegates.

Differences arise due to  biological differences between the sexes, epilepsy drug interactions due to hormonal levels and also the social impact of the condition.

'Women with left temporal lobe epilepsy tend to have a higher rate of polycystic ovary syndrome. This is particularly so if there are also issues around being overweight, with a higher hip to waist ratio. This may also impact on fertility.

'In some men, epilepsy may contribute to erectile dysfunction and  changes in the structure of sperm.'

Dr Luef said that when treating women, doctors should screen for menstrual cycle irregularities, checking seizure diaries for the occurrence of seizure clusters. They should also measure oestrogen and progesterone levels in the serum which can impact on seizure activity.

Doctors should encourage weight reduction where  appropriate and look at changing epilepsy medication if necessary. Family planning and advice around treatment and the potentially harmful effects of sodium valproate to a baby exposed to the drug during pregnancy, should also be discussed.

'If a young woman is newly diagnosed with epilepsy, I would avoid prescribing sodium valproate due to its risk of teratogenicity,' he said. 'However, sometimes we have few options. If sodium valproate is the only choice, I would try and prescribe the lowest dose possible and keep below 1000mg a day.

'Where a woman has catamenial epilepsy linked to her menstrual cycle, she should be advised that this is likely to get better after the menopause.'

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