Evaluation of sex hormones and sperm parameters in male epileptic patients

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Epilepsy is one of the most common chronic disorders of the central nervous system, which has been known since ancient times and is characterized by recurrent unprovoked seizures. Due to its chronic nature, it usually requires a long‐term or even lifelong drug therapy except for some special types of seizures. Higher incidences of reproductive hormone dysregulation and sexual dysfunction are reported in epileptic patients compared to healthy individuals, but the causes are still controversial.1 Incidence of hyposexuality or sexual dysfunction in male epileptic patients varies among the communities with a reported wide range of 20%‐67%.3 Pathologic electrical activity during an epileptic seizure, psychosocial factors and antiepileptic drugs (AEDs) used are considered to contribute to the development of hyposexuality and alterations of reproductive hormone levels.5
It is a usual opinion that the antiepileptic drugs may affect hormonal functions, thereby leading to hyposexuality.2 AEDs cause inhibition of free testosterone (fT) synthesis by a direct effect on testes or decrease fT levels by increasing the levels of sex hormone‐binding globulin (SHBG) and serum estradiol (E2) as a consequence of enzyme induction.8 There are also studies which showed that the AEDs may lead to sexual dysfunction by affecting the sperm concentration and morphology in addition to alterations they caused in sex hormone levels with their effects on hypothalamic–pituitary–gonadal axis.10 AEDs can lead to sexual dysfunction by directly decreasing fT release from Leydig cells in testes.11
Sodium valproate (VPA) increases GABA levels, selectively blocks the voltage‐gated sodium current and acts through the calcium‐dependent potassium channel. It is a broad spectrum AED that is used in all types of seizures.12 Carbamazepine (CBZ) is an iminodibenzyl derivative that is structurally similar to tricyclic antidepressants and acts through the voltage‐dependent sodium channels. It is usually used in partial seizures and secondary generalized seizures. Both AEDs are first‐choice drugs for various seizure types in many countries.1 Both VPA and CBZ have identified side effects on the central nervous system, bone marrow, connective tissue, gastrointestinal tract, and urogenital system. However, there are insufficient data in the literature about the sex hormone alterations and reproductive dysfunction related to use of AEDs in male patients with epilepsy, and the available data are contradictory.
The aim of this study is to investigate the effect of CBZ and VPA used as monotherapy in male epileptic patients on sex hormones, semen analysis, sperm quality, and sexual functions.

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