Hormonal Alterations Following Seizures

Postictal increases in prolactin (PRL), luteinizing hormone, and follicle-stimulating hormone have been recorded in patients with both generalized tonic-clonic and partial seizures. Elevations of PRL and luteinizing hormone were seen immediately and at 20 minutes after generalized tonic-clonic seizures in male and female patients. Usually, PRL blood levels return to normal values within 1 hour. Previous studies have evaluated the utility of the transient increases in PRL, neuron-specific enolase, and S-100 protein as markers of epileptic seizures in children and adults. The conclusion was that measurement of serum PRL is a reliable confirmatory test in the presence of a seizure, but only modestly effective as a screening test for suspected seizures. Temporal lobe epilepsy is associated with abnormalities of reproductive physiology, but the mechanisms of hormonal dysregulation are not clear. A direct influence of epilepsy on the reproductive endocrine system is suggested by acute changes in PRL and gonadotropin levels following generalized and partial seizures, pointing to a possible relationship between temporolimbic epileptiform discharges and particular reproductive endocrine disorders. Chronic effects of the epileptic state and the acute impact of seizures could alter hypothalamic function, as indicated by downstream pulsatile secretion of luteinizing hormone. The brain controls reproductive function primarily through hypothalamic regulation of pituitary secretion regions of the hypothalamus. These are areas that are involved in the regulation, production, and secretion of gonadotropin-releasing hormone and receive extensive direct connections from the cerebral hemispheres, especially from temporolimbic structures, most notably from the amygdala, that are commonly involved in temporal lobe epilepsy. Significant relationships have been uncovered through which ictal and postictal effects of seizures and epilepsy may influence the function of this complex neuroendocrine system.