Gender issues in the neurobiology of epilepsy: A clinical perspective

• Hormones, especially during reproductive periods, influence certain epilepsies.
• In catamenial epilepsy seizures are more frequent in specific menstrual cycle stages.
• Epilepsies may also affect the reproductive system in both men and women.
• The site and laterality of seizure origin may contribute to hormonal dysregulation.

A patient's hormonal milieu contributes to the timing of emergence of several epilepsy syndromes that are known to begin at puberty and recede with the end of reproductive potential.One's hormonal balance at any particular moment contributes to seizure occurrence in both men and women. The best studied condition, catamenial epilepsy, refers to seizure clusters occurring in a cyclical pattern related to menses. Treatment of epilepsy using hormones complements standard antiepileptic therapy and its use will be reviewed, along with some other medications unique to catamenial epilepsy, such as diuretics.Seizures and “silent” epileptiform discharges in turn affect the hypothalamic pituitary axis and can cause release of hormones at inappropriate times leading to sexual dysfunction, menstrual irregularity, infertility and premature termination of reproductive states. Combined with psychological consequences of epilepsy, this sexual dysfunction has deleterious effects on the quality of life in patients and their partners.