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2.6 Ongoing considerations when monitoring epilepsy treatment

The incidence of several conditions may be increased in people with long-term epilepsy, or patients may have specific health concerns. If you are uncomfortable managing these conditions against a background of epilepsy you should seek advice from an epilepsy specialist.

Bone health

Patients treated with carbamazepine, sodium valproate, topiramate, phenytoin, primidone or phenobarbital have an increased risk of reduced bone mineral density with long-term treatment. This may be due to the increased Vitamin D catabolism associated with these AEDs.1

In patients receiving these AEDs it may be advisable to consider vitamin D and calcium supplementation, and refer for a DEXA scan if there is a high risk of osteoporosis.

More information for patients is available at www.epilepsy.org.uk

Mental health

People who are still having seizures are more likely to be depressed than people with controlled epilepsy. It is good practice to screen for depression, anxiety and suicidal ideation during an epilepsy review.

Some older AEDs, such as phenobarbital, phenytoin and primidone may increase the risk of depression as a dose-related side-effect of treatment, while others such as sodium valproate, carbamazepine, lamotrigine and oxcarbazepine can help to stabilise people's moods. Care is need when prescribing anti-depressants as some can lower seizure threshold.

If your patient is feeling low, it is important to remind them that St John's wort may interfere with their AED, as it induces hepatic enzymes involved in their metabolism.

More information for patients is available at www.epilepsy.org.uk

Sexual health

Many people with epilepsy have normal sexual relationships, but a significant number have problems. It is important to note that problems with sex drive are multifactorial and can be affected by low mood or poor self-esteem. Depression is approximately two to three times more common in people with a chronic physical health problem than in people who are in good physical health2 and is now widely acknowledged as a frequent psychiatric comorbidity of seizure disorders.3 For some people, their feelings about their epilepsy may make them lose interest in sexual relationships.

Some AEDs may cause sexual problems by having an effect on hormone metabolism, potentially having a low risk of reducing sex drive.4 AEDs that may lead to reduced sex drive include:4

  • carbamazepine
  • oxcarbamazepine
  • topiramate
  • phenytoin.

Seizures may affect the way the body releases hormones, in turn affecting sexual responses.5 Some men with epilepsy have lower testosterone levels than men who don't have epilepsy, as epileptic activity in the brain may reduce the levels of testosterone in the body, particularly for those with temporal lobe epilepsy.5 AEDs which may lead to lowered sex drive include: 4

  • phenytoin
  • carbamazepine
  • oxcarbazepine
  • phenobarbital
  • primdone
  • topiramate.

Some AEDs may also increase the risk of impotence.5

If a patient is concerned about their sexual health or relationships they should discuss this with their GP. They may need a referral to an epilepsy specialist to discuss changes to AEDs, or possibly to a relationship therapist or psychologist.

If the patient is concerned about their sexual health or relationships they should discuss this with a trusted professional. More information for patients is available at www.epilepsy.org.uk

Conditions affecting specific populations, such as older people or those with learning disabilities are described in Section 1.4.


1 Pack A, 2008. Bone Health in People with Epilepsy: Is It Impaired and What Are the Risk Factors? Seizure. 17: 181-186..

2 National Institute for Health and Clinical excellence (NICE), 2010. Depression in adults with a chronic physical health problem treatment and management. Leicester: The British Psychological Society and London: The Royal College of Psychiatrists.

3 Barry et al. 2008. Consensus statement: the evaluation and treatment of people with epilepsy and affective disorders. Epilepsy Behaviour. 13 Suppl 1:S1-29.

4 Gutierrez MA et al. 2008. Sexual Dysfunction in Women with Epilepsy: Role of Anti-epileptic Drugs and Psychotropic Medications. International Review of Neurobiology. 83: 157-167.

5 Harden CL, 2006. Sexuality in Men and Women with Epilepsy. CNS Spectrums. 11: 13-18.

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