Sexual Dysfunction in Epilepsy and the Role of Anti-Epileptic Drugs

Background: Sexual dysfunction is very common in patients with epilepsy. Objective: We sought to review the published literature around sexual dysfunction in epilepsy, and particularly the role played by anticonvulsant drugs. Method: We searched all related articles on PubMed using the search terms sexual dysfunction, various AEDs and epilepsy, and restricted the search to English language articles. Results: The most common manifestations of sexual dysfunction in patients with epilepsy are hyposexuality and erectile dysfunction. The cause of this dysfunction is multifactorial and overlapping, and includes changes in the levels of sex hormones, anti-convulsants, the epilepsy itself and psychosocial factors. Traditional anti-convulsants which induce the cytochrome P450 enzyme system have the highest rates of sexual dysfunction, which is primarily mediated by changes in sex hormone levels. Sexual dysfunction associated with newer anti-convulsants is likely to occur through different mechanisms. Some anti-convulsants such as oxcarbazepine and lamotrigine may improve sexual function, but can also rarely be associated with sexual dysfunction. Conclusion: Management of sexual dysfunction thought to be caused by anti-convulsants should include the cessation of the offending drug, and consideration of switching to alternative anti-convulsants that have been reported to improve sexual function such as oxcarbazepine, and lamotrigine.