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Welches Antiepileptikum für den Mann?

Kritische Beurteilung aktueller Kenntnisse aus epileptologischer und andrologischer Sicht

Which antiepileptic drug for men with epilepsy?

A critical epileptological and andrological review

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Zusammenfassung

Hintergrund

Die Empfehlungen zur medikamentösen Therapie fokaler Epilepsien berücksichtigen zunehmend geschlechtsspezifische Aspekte in der Auswahl der Antiepileptika (AED). Ziel der Untersuchung war es, die aktuellen Kenntnisse zum Einfluss der AED auf reproduktive Störungen bei Männern mit Epilepsie zu überprüfen.

Methode

Fachartikel zu diesem Themenbereich sowie Übersichtsartikel wurden von einem Nervenarzt mit spezieller Expertise in Epileptologie und von einem Andrologen kritisch bewertet.

Ergebnisse

Die Kenntnisse zur Beeinflussung reproduktiver Funktionen durch AED sind gering, sie beinhalten im Wesentlichen Angaben zur Therapie mit Carbamazepin, Oxcarbazepin, Valproat oder Lamotrigin. Im Wesentlichen unberücksichtigt bleibt der Einfluss der Epilepsieerkrankung selbst, der sich bei einer Temporallappenepilepsie als deutlich darstellt (Minderung von Testosteron). Enzyminduzierende AED erhöhen zwar das an das Sexualhormon-bindende-Globulin (SHBG)-gebundene Testosteron, die mögliche Korrelation zu sexuellen Funktionsstörungen ist aber kaum untersucht. Kasuistisch deutlich sind Effekte einzelner AED auf die Spermatogenese.

Konklusion

Bei einer aus reproduktiver Sicht insgesamt unzureichenden Datenlage fallen am ehesten Berichte zur Therapie mit Lamotrigin (LTG) oder Valproat (VPA) auf, die neutrale (bis positive) Einflüsse dieser AED auf sexuelle Steroidhormone beschreiben. Diese AED erhöhen die Menge des an SHBG-gebundenen Testosteron kaum (LTG) oder nicht (VPA).

Summary

Background

Choice of antiepileptic drugs (AED) in the treatment of epilepsy is partly based on the assessment of drug-induced sexual dysfunction in men. We examined current knowledge on the effect of AED on reproductive functions in men with epilepsy.

Methods

Original publications and review articles were evaluated by an epileptologist and a specialist in andrology.

Results

Only few data are available to assess the effects of AED (i.e. carbamazepine, oxcarbazepine, valproate, and lamotrigine) on male sexual function. Moreover, the effect of epilepsy itself is almost never considered. Temporal lobe epilepsy may however influence the release of sexual steroid hormones, resulting in reduced serum concentrations of testosterone. Enzyme-inducing AED increase the amount of testosterone bound to the sexual hormone-binding globulin (SHBG). However a correlation to sexual functions is not well established. In addition, AED may affect spermatogenesis and sperm motility, possibly resulting in infertility.

Conclusions

Based on current data, lamotrigine and valproate are the AED of choice. These AED have little or no effect, respectively, on SHBG and exert no negative effects on sexual steroid hormones in men.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: J. Bauer erhielt in den letzten Jahren Vortragshonorare von verschiedenen Arzneimittelherstellern. D. Klingmüller erhielt keine Zuwendungen.

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  1. Klinik für Epileptologie, Universitätsklinikum, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland

    J. Bauer

  2. Institut für Klinische Chemie und Pharmakologie, Universitätsklinikum, Bonn, Deutschland

    D. Klingmüller

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Correspondence to J. Bauer.

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Bauer, J., Klingmüller, D. Welches Antiepileptikum für den Mann?. Nervenarzt 79, 1407–1415 (2008). https://doi.org/10.1007/s00115-008-2578-z

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