الفهرس 
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Abstract
The study was conducted for assessment of the reproductive endocrine function in 44 female patients with epilepsy, aged from 15 to 45 years old and currently on antiepileptic medication during the period from January 2011 till June 2012 in the outpatient clinic of Neurology Department, Sohag University Hospital, Sohag, Egypt.
All Patients were subjected to:
A. Detailed medical and neurological evaluation.
B. Assessment of the regularity of menstrual cycles with direct interviews.
C. Transvaginal or transabdominal ultrasonography:For detection of PCO.
D. Standard EEG
E. Laboratory investigations including:
• Electrolyte assessment(Na+, K+,Ca++)
• Random blood sugar.
• Fasting serum cholesterol.
• Liver functions tests.
• Renal functions.
• Complete blood count (CBC).
• Erythrocyte sedimentation rate (ESR).
F. Sex hormonal assay:
• Serum FSH, LH, testosterone and prolactin were assessed in the early follicular phase of the menstrual cycle (cycle days 1-6).
• Serum progesterone was done one week before menstruation (midluteal phase) for assessment of ovulatory function.
Our study found that the prevalence of PCOS in the study subjects was 20.5% and it was strongly associated with uncontrolled patients, generalized epilepsy type, valproate therapy, epilepsy onset at perimenarche period and also the onset of antiepileptic drug(s) at the perimenarche period.
Patients with PCOS had significantly more prevalence of secondary amenorrhea, high LH-to-FSH ratio and high serum testosterone level.
Irregular menstrual cycles were present in 34.1% of the study subjects and were more prevalent in patients with epilepsy onset before menarche.
Ovulatory dysfunction were present in 65.9% of our study subjects (38.6% had luteal phase defect and 27.3% had anovulatory cycles). CBZ was associated with more frequent prevalence of luteal phase defect while VPA was more associated with anovulatory cycles.
Decreased LH and FSH serum level was present in 11.1% of total study subjects and was more common in patients with uncontrolled seizures while high LH-to-FSH ratio was present in 20.5% and occurred significantly more in patients with generalized epilepsy type and patients with PCOS.
Elevated serum testosterone levels was present in 18.2% of patients and was more frequent in patients with uncontrolled seizures and patients with PCOS.
6.2-Recommendations
The comprehensive management of women with epilepsy includes counseling about reproductive issues that relate to epilepsy and antiepileptic drug use, as well as monitoring of reproductive function.
Regular monitoring of reproductive function in epileptic women at visits is recommended, including questionnaire about menstrual disorders, fertility, hirsutism, and galactorrhoea. Patients with reproductive dysfunction may require further assessment with endocrine testing, pelvic ultrasound.
Particular attention should be given to patients with uncontrolled seizure, generalized epilepsy, especially if on valproate therapy, and those with onset of epilepsy or AED at perimenarche or after menarche.