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*Corresponding Author: Sherifa Ahmed Hamed M.D, Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt Telephone: +2 088 2374904 Fax: +2 088 23333227 E-mail: [email protected] Abstract. We aimed to determine the frequency of ED in epileptic adults and its related variables.

Included were 100 epileptic men treated with conventional antiepileptic drugs (AEDs).

Patients were assessed using International Index of Erectile Function questionnaire-5 items version (IIEF-5), psychiatric interview, Beck Depression Inventory (2nd edition) (BDI-II) and Hamilton Anxiety Rating Scale (HAM-A). Free testosterone and sex hormone binding globulin (SHBG) were measured to assess endocrinal status. Compared to controls (n=50), patients had higher rates of ED (37%), lower IIEF-5 scores (P=0.053), particularly with frontal lobe epilepsy, left foci, carbamazepine (CBZ) and uncontrolled seizures.

A high frequency of depression (51%) and scores of BDI-II were reported with frontal lobe epilepsy, right foci, CBZ, polytherapy and lack of control on AEDs. Lower free testosterone and higher SHBG levels were also reported.

Patients with ED were older in age, had higher rates of uncontrolled seizures (58.19%) and higher scores of BDI-II and HAM-A. A significant negative correlations were identified between ED and age, age at onset, scores of BDII and HAM-A. We concluded that psychiatric comorbidity and endocrine abnormalities appear to be related to ED and seizure intractability to AED medications. Attention should be paid to optimize seizure control. In addition, psychotherapy and modalities such as medications for ED are sometimes needed. Erectile dysfunction; sildenafil teva 100mg price

epilepsy

GTC: Generalized tonic-clonic; AEDs, antiepileptic drugs; CBZ: carbamazepine; VPA: valproate; EI-AEDs: enzyme inducer antiepileptic drugs; TLE: temporal lobe epilepsy; SHBG: sex hormone binding globulin; IIEF-5: International Index of Erectile Function questionnaire – 5 items version; BDI-II: Beck Depression Inventory (2nd edition); HAM-A: Hamilton Anxiety Rating Scale.

Epilepsy is one of the most common chronic medical illnesses [1].

Men with epilepsy have an approximately five-folds increase in risk of sexual dysfunction compared to general population [2].

In general, sexual disorders are common in people with epilepsy, occurring in up to 1/2-2/3 of patients [3-6].

Various aspects of sexual functions are affected in men with epilepsy including sexual interest and poor sexual performance (as diminished Libido, potency, or satisfaction of erection or orgasm and premature ejaculation) [7].

Erectile dysfunction (ED) is defined as a failure to persistent or recurrent partial or complete obtaining and/or maintaining penile erections until the end of sexual activity.

The etiology of ED in patients with epilepsy is multifactorial, involving neurological, endocrine, iatrogenic and psychosocial.

ED may be due to disturbance of sex hormones, hypothalamic-pituitary axis and testicular function by epileptic discharges [3, 8,9], or may result as adverse effect of antiepileptic drugs (AEDs) [10-12].

Reduced serum levels of free testosterone and/or albumin bound testosterone and sildenafil tablet price free androgen index (FAIs) and increased levels of estradiol (E2), sex hormone binding globulin (SHBG), follicle stimulating hormone (FSH), luteinizing hormone (LH) and prolactin were reported in men with epilepsy [3-6].

Enzyme inducer AEDs (EI-AEDs) as carbamazepine (CBZ), phenytoin (PHT) and phenobarbitone (PB) elevate SHBG and reduce bioactive testosterone levels and may result in impotence in men [13, 14].

Epilepsy signifies anxiety and depression, low self-esteem and immaturity and this could lead to avoid situations that call for affective sexual involvement [15-18].

In this work, we aimed to determine the frequency rate of ED in a cohort of adult men with epilepsy and its relation to demographic-, clinical-, epilepsy-, psychosocial- hormonaland treatment- related variables.

This study was conducted on 100 adult males with epilepsy, with age ranges between 20 to 48 years and total time of illness ranged from 3 to 35 years. Patients were on regular treatment with one or combined therapy of the conventional AED(s) for at least 6 months before participation in our study.

Patients teva sildenafil coupon were free from other neurological or medical diseases and had normal computer tomography (CT) or magnetic resonance imaging (MRI) of the brain.

Their seizure types’ were diagnosed according to the International League Against Epilepsy (ILAE) [19].

Patients were recruited from the out-patient epilepsy clinics of the departments of Neurology and Psychiatry of Assiut and Al-Azhar University Hospitals, Assiut, Egypt.

Fifty healthy males matched for age, sex, educational level and socioeconomic status were included as controls for comparison. Controls were recruited from the healthy general population matched for age- (range: 20-48 years; mean: 30.36±7.59), sex-, educational level and socioeconomic status.

Excluded were subjects (patients and controls) cost of generic sildenafil with: 1) history of neurological disorder other than epilepsy, 2) history of clinically significant genitourinary disease, pelvic trauma, pelvic surgery, or radiation therapy, 3) concomitantly known vascular risks (e.g., heavy smoking, diabetes mellitus (DM), coronary artery disease) , systemic illness (e.g. gout, active gastrointestinal disease, renal failure, serum creatinine concentration >150 mmol/l, chronic hepatic illness) likely to affect erectile function, 4) alcoholism or diagnosed substance abuse and/or previous hospitalization for substance abuse), 5) use of regular medication(s) in

addition

drugs for high blood pressure, heart medications, antidepressants, tranquilizers, and sedatives), and 6) current or recent treatment of ED with intracorporeal injection or application of vasoactive drugs.

The study protocol was approved by the ethical committee of the faculties of medicine of Assiut and Al-Azhar, Assiut, Egypt and all patients and control subjects gave their informed consent to participate in this study as follow: Methods. All patients and healthy control subjects underwent the same research protocol.