Association between epilepsy and risk of sexual dysfunction

Both female and male patients with epilepsy are at risk of sexual dysfunction, according to a meta-analysis.

The evaluation in Seizure: European Journal of Epilepsy also concluded that male epilepsy patients had a higher risk of sexual dysfunction than female patients and that the high prevalence of sexual dysfunction in patients with epilepsy may be multifactorial.

In response to mounting evidence that both male and female patients with epilepsy have an increased risk of developing sexual dysfunction, the Chinese authors sought to quantify the association between these two conditions.

Nine pertinent studies from PubMed, Embase and Cochrane Library databases from inception to May 2018 comprised the meta-analysis: three cross-sectional, five case-controlled and one cohort trial, for a total of 1,556 subjects and 599 cases of epilepsy. The relative risk (RR) for sexual dysfunction with a 95% confidence interval (CI) was then calculated.

Synthesis results demonstrated that epilepsy was associated with an increased risk of female sexual dysfunction in six studies (pooled RR = 2.69, 95% CI: 1.48 – 4.89, P = 0.001; and for heterogeneity: I² = 88.9%, P < 0.001). Epilepsy was also connected to male sexual dysfunction in three studies (pooled RR = 4.85, 95% CI: 2.01–11.7, P< 0.001; and for heterogeneity: I² = 74.2%, P = 0.021).

Grading of recommendations assessment, development, and evaluation (GRADE) showed that rates of sexual dysfunction in patients with epilepsy and in controls were 58.1% and 16.5%, respectively.

Among females, the rates were 59.1% and 19.5%, respectively, and for males 58.6% and 9.8%, respectively.

Overall, the quality of evidence across outcomes was MODERATE.

One of the mechanisms that may contribute to development of patients with epilepsy is the innate nature of impairments in the nervous system, including the origin site of the seizure and different types, duration, and frequency of epileptic seizure. Endocrine disorder, antiepileptic drug (AED) usage, psychiatric illness, and psychosocial deficits may also play a role.

The authors noted that sexual behavior is controlled by the brain and that epilepsy is a brain lesion disease. Among patients with epilepsy, the rate of sexual dysfunction is markedly higher in people with temporal lobe epilepsy, particularly on the right, compared to those with extratemporal and primary generalized epilepsies.

A previous study found that anterior temporal lobectomy resulted in postoperative seizure freedom in over 60% of patients who were AED-resistant. Further, most patients who had the surgery achieved an appreciable improvement in sexual function. 

Abnormalities in secretion of sex hormones correlate to the etiology of sexual function in both males and females with epilepsy. Increasing evidence suggests that epilepsy might affect the hypothalamic–pituitary–testicular axis or the hypothalamic-pituitary-ovarian axis.

Bioactive testosterone, which plays a pivotal role in sexual functioning in both men and women, is dramatically lower in both male and female patients with epilepsy compared to healthy individuals, indicating a consequent hyposexuality in the patient with epilepsy.

Findings from the meta-analysis “suggest that both clinicians and patients should recognize that epilepsy has a potential hazardous effect on sexual functioning,” the authors wrote. Therefore, when treating epilepsy, sexual functioning assessment should be considered.