BERKELEY, CA (UroToday.com) - Epilepsy is one of the most common chronic neurological diseases, affecting people of all ages and genders around the world. The main symptom of epilepsy is the occurrence of spontaneous recurrent seizures; however, it is not the only consequence in the quality of life of those affected by this neurological condition. Unfortunately individuals with epilepsy suffer other comorbities such as sexual dysfunctions. The unpredictability of seizures, anticonvulsant medications, alterations induced by epilepsy itself, and psychological state are factors that can corroborate in causing sexual dysfunction in epilepsy.
In the epilepsy field, control of seizures of patients is the main goal for clinicians, and this fact reflects in the scientific research. Indeed, few investigations regarding sexual dysfunction and epilepsy were published in the recent literature, and mainly in men. In this context, erectile dysfunction (ED) is a common complaint in this group, including men with a median age of just 27.[3, 4] Phosphodiesterase type 5 inhibitors (PDEI-5) such as sildenafil, tadalafil, and vardenafil were launched in the market with promising results, and they are the first drug choice in the treatment of ED. Even with the lack of studies concerning the effects of PDEI-5s on epilepsy, this class of medication is recommended for individuals with spontaneous recurrent seizures. However, strong evidence from preclinical studies and case reports raised doubt about the safety of PDEI-5s in epileptic men, since case reports described seizures in individuals without epilepsy.[5, 6, 7] It is important to mention that there are other reasons, including epilepsy itself, that can corroborate for paroxysmal phenomenon beyond PDEI-5. For instance, seizures from reflex epilepsy can be triggered by orgasm.
The possible role of PDEI-5s in seizure susceptibility should be taken into account, certainly by urologists who have patients with epilepsy. The quality of life of this neurological group is a priority for the medical community, however, similar to seizure control, precaution in the prescription of medications can be adopted with individuals with lower thresholds for seizures.
- Matos G, Scorza FA, Cavalheiro EA, Tufik S, Andersen ML. PDEI-5 for Erectile Dysfunction: A Potential Role in Seizure Susceptibility.J Sex Med 2012. In press.
- Matos G, Alvarenga TA, Tufik S, Andersen ML. Sexual behavior and epilepsy: the reasons beyond medications. Epilepsia 2012. In press.
- Silva HC, Carvalho MJ, Jorge CL, Cunha Neto MB, Goes PM, Yacubian EM. Sexual disorders in epilepsy. Results of a multidisciplinary evaluation. Arq Neuropsiquiatr 1999;57:798–807.
- Nikoobakht M, Motamedi M, Orandi A, Meysamie A, Emamzadeh A. Sexual dysfunction in epileptic men. Urol J 2007;4:111–7.
- Gilad R, Lampl Y, Eshel Y, Sadeh M. Tonic-clonic seizures in patients taking sildenafil. BMJ 2002;325:869.
- Striano P, Zara F, Minetti C, Striano S. Epileptic seizures can follow high doses of oral vardenafil. BMJ 2006;333:785.
- Okuyucu EE, Guven O, Duman T, Gorur S, Melek IM, Akcin S, Yilmazer S. EEG abnormalities during treatment with tadalafil, a phosphodiesterase type 5 inhibitor. Neurol Res 2009;31:313–5.
- Berthier M, Starkstein S, Leiguarda R. Seizures induced by orgasm. Ann Neurol 1987;22:394–5.Luef GJ. Epilepsy and sexuality. Seizure 2008; 17:127–30.
Gabriela Matos, PhD, Sergio Tufik, MD, PhD, and Monica L. Andersen, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Departamento de Psicobiologia
Universidade Federal de São Paulo (UNIFESP)
Sao Paulo, Brazil