Weight Reduction Aids Antiepileptic Therapy to Restore Ovarian Functions of Epileptic Polycystic Ovary Women

Objectives: To evaluate the hormonal profile of epileptic women with polycystic ovary (PCOS) and to determine the impact of weight reduction regimen on their ovulatory function in comparison to nonepileptic PCOS women and normal fertile control women. Patients and Methods: The study included 60 PCOS diagnosed depending on the Rotterdam criteria, 40 women were epileptics and 20 women were non-epileptics. The epileptic disorders were classified in accordance with the International League Against Epilepsy (ILAE) Classification and treatment 2010, remained constant throughout the whole study period. In all patients transvaginal ultrasonographic (TVU) examination was performed and body weight (BW) and height were measured to calculate body mass index (BMI). Blood samples were obtained in the early follicular phase of the baseline cycle (days 5-7) for hormonal profile determination. All PCOS women were prescribed the same energy-restricted, high-protein diet and underwent a walking/jogging program comprising five sessions per week for 6 months and hormonal profile was repeated. Results: Among women with epilepsy, 25 patients had cryptogenic generalized epilepsy and 15 patients had cryptogenic localization-related epilepsy, 24 patients were on therapy and 16 were untreated. All studied patients showed significantly higher BW and BMI compared to control group. Weight reduction regimen resulted in significant reduction of BW and BMI of PCOS women compared to baseline measures with non-significant difference among studied groups. Baseline estimation of serum hormones profile showed discrepant results that were significantly deviated in all studied women from the control levels. The impact of epileptic therapy was evident and manifested as significantly lower FSH, LH and prolactin (PRL) in untreated women compared to controls, non-epileptic patients and epileptic patients receiving treatment. Serum E2 showed significant increase in non-epileptic patients, but was non-significantly increased in epileptic patients compared to baseline levels. Patients maintained on VPA showed significantly higher serum FSH, PRL and testosterone with significantly lower serum E2 compared to those receiving other forms of antiepileptic therapy. Nineteen women got ovulation with success rate of 31.7%; 11 women were non-epileptic, 6 women on antiepileptic therapy and only 2 of women who were untreated. Conclusion: In epileptic PCOS women when polytherapy was provided with avoidance of VPA, combined weight reduction regimens associated with aerobic physical exercise intervention induce weight loss with subsequent amelioration of inhibitory effect of obesity on the reproductive function and adjustment of the hyperandrogenic milieu and induction of ovulatory cycles that promise for regaining fertility.