Drugs & Meds Blog

Interictal phenomena

Many men with epilepsy suffer from loss of sexual desire, reduced sexual activity, and/or inhibited sexual arousal (Saunders & Rawson 1970, Dansky et al 1980, Goldner & Morrell 1995). Inability to maintain erection and, more rarely, ejaculatory dysfunction, decreased satisfaction with sexual life, reduced sexual fantasies, reduced sexual dreams and initiatives and reduced orgasmic capacity, have been reported in patients with complex partial epilepsy and mesio-basal temporal lobe spike foci (Taylor 1969, Shukla et al 1979). Morrell et al (1994) noted that sexual dysfunction was more frequent in partial than in generalised epilepsies. Decreased sexual arousability, vaginism and dyspareunia occur (Demerdash et al 1991) and episodic hypersexuality has been reported in a few cases (Blumer 1979). Sexual interest seems to be reduced particularly with right temporal foci compared to left hemisphere disorders. Surgical management of the epilepsy does not appear important (Christianson et al 1995), although life satisfaction and sexuality scores are higher in patients seizure-free compared to those experiencing seizures. Epileptic patients, especially men, have a lower expectation of marriage than the general population, and married women with epilepsy have fewer children than expected (Dansky et al 1980). Epileptic patients describe poorer psychological health than healthy subjects. Antiepileptic drugs, especially the older types (phenytoin, phenobarbital, primidone, carbamazepine and valproate), may lead to hormonal changes (particularly increased oestradiol and decreased free testosterone levels in men), as well as decreased sexual desire and performance in both sexes (Isojärvi et al 1995, Duncan et al 1999, Bauer et al 2004). Menstrual irregularities are common among women with epilepsy (for review, see Lundberg 1997b).

Seizures and sexual phenomena

Epilepsy and sexual behaviour may be connected in many ways. Thus, sexual activity may provoke an epileptic attack (perhaps due to hyperventilation), sexual phenomena may be a part of an epileptic seizure, and the epileptic patient may display changes in sexual behaviour (Lundberg 1992). Sexual fantasies as well as genital stimuli (masturbation) or orgasm (Berthier et al 1987, Calleja et al 1988) may perhaps trigger reflex epilepsy. Partial seizures generated from a genital sensory cortical area may result in sensations in the genital organs, e.g, clitoral or vaginal warmth, a pleasant sensation of anal or vaginal constriction or of penetration but also as attacks of actual genital pain. Almost all of the very few described cases have been associated with a parasagittal tumour involving the primary sensory cortex. Motor symptoms such as erection, lubrication, ejaculation or orgasm may also be a part of a seizure. Such genital events may or may not be experienced as sexual. Pelvic sexual movements, as a part of epileptic automatisms, or compulsive masturbation in front of other people may occur during or after a seizure, but these movements are more commonly seen in non-epileptic attacks. Sexual phenomena other than sensory events, occurring as part of an epileptic seizure usually feature in patients with complex partial epilepsy, most often with temporal lobe lesions. Sexual automatisms may also occur with frontal lobe lesions. They are very uncommon in primary generalised epilepsy (with generalised tonic-clonic or absence seizures).

Deviant sexual behaviour, such as exhibitionism, fetishism, frotteurism, sadomasochism, transvestism, and violent sexual or pansexual behaviour, is a rare manifestation of epilepsy. The fact that the behaviour in question may occur episodically and sometimes disappears after treatment favours a causal connection between the behaviour and the epilepsy, or the causative cerebral lesion. In most cases there were partial complex epileptic seizures and lesions in one or both temporal lobes. Sometimes the deviant behaviour correlates with epileptic discharges in the EEG, e.g., in psychomotor status). In addition, paranoid delusions of being violated, abused or seduced are not uncommon in epileptic patients (Lundberg 1992).

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