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- W2016175501 abstract "We read with great interest the article by Metin et al.1Metin S.Z. Ozmen M. Ozkara C. Ozmen E. Hypersexuality in a patient with epilepsy during treatment of levetiracetam.Seizure. 2012; (pii: S1059-1311(12)00291-9)https://doi.org/10.1016/j.seizure.2012.11.002Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar dealing with the possible correlation between hypersexuality and levetiracetam (LEV). Indeed, the authors reported a female patient with epilepsy who experienced increased sexual drive after the addition of LEV (2000 mg/day) to her ongoing carbamazepine (CBZ) therapy. Although the association between epilepsy and sexual-dysfunction (SD) has often been described, to date, the aetiology of SD-related epilepsy remains uncertain, but likely to be multifactorial involving neurological (type of epilepsy, age of onset, seizure frequency), endocrine (effect of epileptiform activity on the hypothalamic–pituitary–gonadal axis), iatrogenic (antiepileptic drugs, antidepressant) psychiatric (anxiety and depression), cognitive and psychosocial factors.2Lambert M.V. Seizures, hormones and sexuality.Seizure. 2001; 10: 319-340Abstract Full Text PDF PubMed Scopus (85) Google Scholar, 3Calabrò R.S. Marino S. Bramanti P. Sexual and reproductive dysfunction associated with antiepileptic drug use in men with epilepsy.Expert Review of Neurotherapeutics. 2011; 11: 887-895Crossref PubMed Scopus (54) Google Scholar In particular, liver enzyme-inducing antiepileptic drugs (AEDs), i.e. phenobarbital, phenytoin, and carbamazepine, can cause SD by decreasing bioactive testosterone, accelerating sexual hormone metabolism, and stimulating binding hormone proteins production. Conversely, new AEDs, including topiramate, zonisamide, oxcarbazepine, lamotrigine and pregabalin, are thought to cause SD through complex and poorly understood mechanisms.4Calabrò R.S. Sexual disorders related to new antiepileptic drugs: a need for more studies!.Epilepsy & Behavior. 2011; 20: 734-735Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Although Svalheim et al.5Svalheim S. Taubøll E. Luef G. Lossius A. Rauchenzauner M. Sandvand F. et al.Differential effects of levetiracetam, carbamazepine, and lamotrigine on reproductive endocrine function in adults.Epilepsy & Behavior. 2009; 16: 281-287Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar have demonstrated that LEV treatment apparently has no drug-specific sexual or endocrine side effects in men or women aged 45 years, a few case reports are emerging from the literature showing a possible correlation between SD and LEV ingestion. Indeed, alongside the interesting case of LEV-induced hypersexuality by Metin et al., we have recently reported two young men with epilepsy who experienced severe loss of libido and anhedonia after LEV intake.6Calabrò R.S. Italiano D. Militi D. Bramanti P. Levetiracetam-associated loss of libido and anhedonia.Epilepsy & Behavior. 2012; 24: 283-284Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar Levetiracetam is a new AED exerting its antiepileptic effect through multiple and poorly understood mechanisms of action. Synaptic vesicle glycoprotein 2A vesicular membrane protein appears to be the main pharmacological target, but several effects on ion channels have been described, including blockade of high-voltage-activated Ca2+ channels, modulation of K+ channels, and enhancement of GABA- and glycine-gated currents. In particular, LEV-induced inhibition of presynaptic P/Q-type calcium channels has been demonstrated to increase brainstem serotonin concentration in mice, with a consequent imbalance in dopamine/serotonin rate leading to alteration in emotion-related behaviour.7Takahashi E. Niimi K. Itakura C. Levetiracetam-mediated emotional behavior in heterozygous rolling Nagoya Ca(V)2.1 channel mutant mice.Pharmacology Biochemistry & Behavior. 2010; 96: 294-300Crossref PubMed Scopus (6) Google Scholar Thus, since LEV did not appear to alter the sex hormonal profile, other possible pathomechanisms leading to SD should be considered. Indeed, given that sexual desire and pleasure are mainly related to CNS dopamine levels, it is hypothesizable that LEV-induced loss of libido (as in the patient reported by our group)6Calabrò R.S. Italiano D. Militi D. Bramanti P. Levetiracetam-associated loss of libido and anhedonia.Epilepsy & Behavior. 2012; 24: 283-284Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar or hypersexuality (as in the patient by Metin et al.1Metin S.Z. Ozmen M. Ozkara C. Ozmen E. Hypersexuality in a patient with epilepsy during treatment of levetiracetam.Seizure. 2012; (pii: S1059-1311(12)00291-9)https://doi.org/10.1016/j.seizure.2012.11.002Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar) may be related to alterations in brain excitatory transmission (sexual drive and arousal) by unbalancing the dopamine/serotonin ratio. In conclusion, as individuals with epilepsy may not spontaneously complain of SD, we recommend a wide assessment of their sexual function, because even new AEDs, including LEV, may cause sexual disorders through complex and still poorly understood neurobiological mechanisms." @default.
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- W2016175501 title "Levetiracetam-induced sexual disorders" @default.
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