Women with epilepsy face challenges to their reproductive health which impact their quality of life. Reduced fertility, anovulatory menstrual cycles, reproductive endocrine disorders, polycystic ovaries and decreased sexual desire and arousability have been described in women with epilepsy. Little quantitative data is available to establish incidence and types of reproductive dysfunction, nor have mechanisms of dysfunction been elucidated. A series of controlled, prospective studies is proposed to characterize deficits in reproductive function in women with epilepsy, and to identify the mechanisms of dysfunction. These studies will evaluate subjective sexual function, stimulus-induced physiological sexual arousal, reproductive endocrine status, and ovulatory adequacy. Three groups of women with epilepsy (women with localization related epilepsy of temporal lobe origin [TLE], localization related epilepsy of extratemporal lobe origin [ETLE], and primary generalized epilepsy [PGE]) and a control group will be compared in order to assess the study hypothesis that TEL is more often associated with reproductive disorders than other types of epilepsy. A fifth group comprised of patients who are candidates for surgical removal of an epileptogenic focus will be examined pre-and post-surgery, providing insight into reproductive function after ablation of an epileptogenic focus with the antiepileptic drug (AED) variable remaining constant. Elucidating the frequency and mechanisms of sexual and reproductive endocrine dysfunctions in women with epilepsy will have important clinical implications. Understanding etiologies of sexual and endocrine dysfunctions in women with epilepsy will lead to specific therapeutic strategies, including hormonal manipulation and alternative selection of AEDs. The ultimate goal is to educate health care providers and consumers about the reproductive health issues that women with epilepsy face. Finally, the sexual and reproductive endocrine dysfunctions associated with epilepsy could serve as a model for understanding neural and hormonal pathways mediating reproductive function and behavior.
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