Epilepsy and Sexual Dysfunction

Author: beatrice bacco
Date: 17/07/2012


Neurological disorders (stroke, temporal lobe epilepsy, spinal cord injuries) are often causally related to sexual dysfunction .
Sexual dysfunction may arise more frequently in men and women with epilepsy than with other chronic illnesses, manifesting primarily as diminished sexual desire and potency.

Epilepsy is a neurological disorder that can be chronic or episodic and transient (if there is a single episode that no longer occurs during the life),characterized by the onset of crisis.

Seizures are classified in:
•partial seizures:

  • crisis elementary or “simple”
  • complex partial seizures
  • complex partial seizures secondarily generalized

  • •generalized seizures:
  • petit mal (“absences”)
  • grand mal (“tonic-clonic”)
  • tonic
  • atonic
  • myoclonic

  • •others:
  • neonatal seizures
    • infantile spasms

      Sexual dysfunction may be more common in partial than in generalized epilepsies.
      Recent studies show that there is some correlation between the onset of epilepsy and sexual problems, these problems manifest themselves in a percentage that varies between 25 and 30%, not counting the episodes are not reported to the physician (as deemed irrelevant or embarrassment), occur equally in both sexes (though more evident and reflected in the male)

      However, it is difficult to differentiate between the impact of the disease and the impact of antiepileptic drugs on sexual function in human subjects.

      The causes of sexual dysfunction are not yet fully known, but certainly can be traced to a multifactorial etiology. Besides reasons of a psychological (low self-esteem, depression) there may be physiological causes such as the alteration of hormonal regulation or the effect of the crisis on Brain centers that control sexual function and libido. But there may also connect to traditional nonsteroidal anti epileptic drugs such as phenytoin, carbamazepine, valproate (which depress sexual function), the effect is reduced for new generation drugs. Antiepileptic drugs modulate hormone release from the hypothalamic-pituitary-gonadal axis and may have direct inhibitory effects on sexual behavior.

      Assuming therefore a correlation between epilepsy and sexual dysfunction, the first experiment consisted of subjecting rats treated with pilocarpine, in a case-control study, where the control was given by non-epileptic rats, subjected to 9 treatment sessions, the case instead it was given from rats in which was induced epilepsy, have gone to evaluate the following parameters:

      1. Latency to first mount
      2. Latency to intromission
      3. Latency to eiaculation
      4. Number of mounts
      5. Number of intromissions
      6. Number of ejaculations

      All parameters were lower in the group of rats with epilepsy compared with healthy controls. This experiment can help to find out something about the mechanisms in humans.


      A second considerable analysis was projected to assess the effects of the testosterone levels and indices of anxiety and depression on sexual function in men with epilepsy. Sixty men with epilepsy treated with one drug and not taking other antiepileptic drugs, were compared with a control group of 60 men. We measured the levels of testosterone (TT), free testosterone (FT), bioactive testosterone (BAT), dehydroepiandrosterone sulfate (DHEAS), androstenedione and SHBG (sex hormone-binding globulin). In addition, each of the study participants completed a questionnaire with questions related to sexual desire (Sexual Desire Inventory [SDI]), sexual response (Sexual Response Inventory [SRI]), erectile function (Sexual Self-Efficacy Scale [SSES]) and anxiety and depression (Hospital Anxiety and Depression Scale).
      Men with epilepsy have reported lower levels of sexual desire and lower erectile function compared to controls. They also had significantly higher levels of anxiety, depression and psychological distress. The SHBG levels were significantly higher in epileptics, while those of DHEAS were significantly lower. There were no differences between the two groups with respect to testosterone levels, bioactive testosterone and free testosterone. BAT levels were significantly lower in men treated with enzyme-inducing AEDs than in those taking non-enzyme-inducing AEDs. Most people with epilepsy and controls showed levels of bioactive testosterone and free testosterone above the threshold of 12 nmol / L for TT and 3.8 nmol / L for BAT, which is considered necessary for normal sexual function. There was a statistically significant correlation between sexual function and indices of anxiety and depression, whereas no correlations were found between sexual desire and erectile function and testosterone, free testosterone or bioactive testosterone. In conclusion, based solely on hormone levels to explain the sexual dysfunction in patients with epilepsy is a simplistic approach to the problem. Future studies should also pay attention to measures of quality of life, anxiety and depression. (Xagena_2008) Talbot J A et al, Neurology 2008, 70: 1346-1352


      A third project tested sexual response in men and women with partial epilepsy of temporal lobe origin (TLE) by measuring genital blood flow (GBF) during sexual arousal. Nine women and eight men with TLE and 12 women and 7 men as controls completed inventories for symptoms of depression, sexual experience, and sexual attitude and underwent measurement of digital pulse and GBF during alternating segments of sexually neutral and erotic videotape. Subjective ratings of arousal to the videotape were obtained. We calculated digital pulse and GBF response as the percentage increase in pulse amplitude during the erotic compared with the preceding sexually neutral film. No subject group reported symptoms of significant depression on the inventory. However, men and women with epilepsy had fewer sexual experiences than subjects without epilepsy, and women with epilepsy imagined specific sexual activities to be more anxiety-producing and less arousing than did women without epilepsy. Men and women with TLE had a diminished GBF response. The mean increase in GBF in men with TLE was 184% versus 660% for controls (p = 0.01). Women with TLE had a mean increase of 117% versus 161% for controls (p > 0.01). Digital pulse did not vary across stimulus conditions. Subjective ratings for all groups indicated moderate sexual arousal. We conclude that there is a diminution in one aspect of physiologic sexual arousal in some men and women with TLE.
      1994 © by the American Academy of Neurology

      On the other hand, Kluver and Bucy described a syndrome (Kluver- Bucy Sindrome), seen in primates but found in men too, in which bilateral temporal lobectomies were associated with hypersexuality, with a marked decrease of anger and fear, the constant need to take everything to the mouth ( “oral tendencies”) and inability to recognize objects ( it is named “psychic blindness”)


      Specific evaluation and treatment protocols for patients with sexual dysfunction are available.

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