Individuals with epilepsy are 1.5x as likely to exhibit PCOS symptoms and have heightened levels of androgens.[1]  They are also more likely to have polycystic ovaries (PCO), particularly if they have idiopathic generalized epilepsy (IGE)[2], a common form of epilepsy with genetic causes.[3]  Some medications for epilepsy are associated with absent, infrequent or prolonged menstruation in up to 50% of individuals.[4] In this article we explore the link between PCOS and epilepsy.

Epilepsy is a disorder of the brain characterized by seizures, short alterations to normal brain activity.[5]  Seizures are believed to interfere with the balance of the hypothalamic-pituitary-ovarian (HPO) axis.[6],[7] 

Anti-seizure medications (ASMs) or anti-epileptic drugs (AEDs) may also cause abnormalities with PCOS-like symptoms due to interference with the functioning of the HPO axis.[8]

Similarly to PCOS, seizures are believed to lead to an increase in the activity level (pulse frequency) of one of the hormones produced in the hypothalamus, the Gonadotrophin Releasing Hormone (GnRH).[9]  This results in the chain of events leading to elevated levels of androgens, or sex hormones (androstenedione and testosterone).[10]

ASMs/AEDs are believed to interfere with the HPO axis through two different mechanisms which result in an increase in circulating androgens:[11]

• Liver: reduces the activity of epoxide hydrolase (EH), key enzymes or biological catalysts that are involved in detoxification,[12] and leads to reduced conversion of androgens; and

• Theca cells within ovary: increases histone acetylation, the mechanism by which luteinizing hormone (LH) regulates production of androgens.[13]

There are a variety of causes of epilepsy including:[14]

• Brain damage from prenatal or perinatal causes (e.g. a loss of oxygen or trauma during birth, low birth weight);

• Congenital abnormalities or genetic conditions with associated brain malformations;

• A severe head injury;

• A stroke that restricts the amount of oxygen to the brain;

• An infection of the brain such as meningitis, encephalitis or neurocysticercosis,

• Certain genetic syndromes; and

• A brain tumour.

Reviewed by Jacqueline French MD, Chief Medical and Innovation Officer and Research Editor of the Epilepsy Foundation, professor in the New York University (NYU) Department of Neurology and Comprehensive Epilepsy Center and founder/director of the Epilepsy Study Consortium.

PARTNER SPOTLIGHT

The Epilepsy Foundation has shone a light on epilepsy for more than 50 years by promoting awareness and understanding, advocating for laws that matter to people with epilepsy and funding epilepsy research. The mission of The Epilepsy Foundation is to improve the lives of people affected by epilepsy through education, advocacy, research, and connection.

Sources

[1] https://aepi.biomedcentral.com/articles/10.1186/s42494-023-00125-4

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198730/

[3]https://health.usf.edu/medicine/neurology/epilepsy/~/media/Files/Medicine/Neurology/Comprehensive%20Epilepsy%20Program/IGEENG.pdf

[4] https://pubmed.ncbi.nlm.nih.gov/34992582/

[5] https://www.cdc.gov/epilepsy/about/faq.htm

[6] https://pubmed.ncbi.nlm.nih.gov/34992582/

[7] https://www.sciencedirect.com/science/article/pii/S1059131103000669

[8] https://pubmed.ncbi.nlm.nih.gov/34992582/

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198730/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198730/

[11] https://pubmed.ncbi.nlm.nih.gov/34992582/

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792612/

[13] https://pubmed.ncbi.nlm.nih.gov/22155568/

[14] https://www.who.int/news-room/fact-sheets/detail/epilepsy