In addition, seizures and antiepileptic drugs have been associated with alterations in the hypothalamic pituitary gonadal axis which appear to contribute to the high incidence of infertility, menstrual irregularities and pregnancy complications identified in this population. There are several implications of the basic biological gender differences in epilepsy, which concern on treatment and clinical care. First, specific antiepileptic drugs may have preferential effects on the hypothalamic. Antiepileptic drugs that inhibit liver enzymes are more likely to be associated with hyperandrogenemia and polycystic ovaries. Drugs that enhance activity of liver enzymes are associated with reductions in endogenous steroid hormones.
Antiepileptic drugs are also teratogenic.
Therefore, the choice of an antiepileptic drug for a woman of reproductive age is best made only when that drug s effects on reproductive health can be understood. Better understanding of hormone-seizure relationships may also lead to novel antiepileptic therapies based on manipulation of endogenous steroid hormones or administration of exogenous hormones. There are many areas of needed scientific investigation. At the molecular level, we require better understanding of how estrogen and progesterone mediate their effects on neuronal excitability in order for therapies to be targeted at that level. Effects of seizures and of antiepileptic drugs on hypothalamic pituitary axis function must be elucidated.