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Many hormones including steroid hormones and thyroid hormone alter the excitability of neurons of the cerebral cortex and thereby alter the seizure threshold. Seizures also change the endocrine environment, probably through actions on the hypothalamic-pituitary axis, leading ultimately to changes in secretion of gonadal steroids. The sex steroid hormones alter GABA-mediated inhibition and glutamate-mediated excitation. For example, estrogen increases the likelihood of a seizure while progesterone decreases it. In addition, some antiepileptic drugs further complicate hormone-seizure interactions. Therefore, there is an increased frequency of infertility, reproductive endocrine deficits, and sexual dysfunction as well as an increased risk for osteopenia and osteoporosis in patients with epilepsy. A greater understanding of the hormonal effects on seizure threshold and the changes in the neuroendocrine system associated with seizure might lead to more adjunctive treatment modalities other than current antiepileptic medications. Careful monitoring of neuroendocrine changes as well as seizure control is required in patients with epilepsy.
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