Hypersexuality in a patient with epilepsy during treatment of levetiracetam

Sexual dysfunction is commonly reported by patients with epilepsy, the prevalence is not clearly defined and is different by gender. Although older studies found higher frequencies, studies with structured interviews reported the prevalence to be 20% in male patients and 20–30% in female patients. The most frequent epilepsy associated sexual dysfunctions are decreased libido and potency problems in men and hyposexuality and orgasmic dysfunction in women. Many hormones of the hypothalamic–pituitary axis related to sexual functions are affected in patients with epilepsy. Antiepileptic drugs such as carbamazepine and phenytoine are enzyme inducers which cause reduction in the levels of testosterone in men and estrogens in women and contribute to sexual dysfunction. Lamotrigine and levetiracetam, which are neither enzyme inducers nor enzyme inhibitors, have been shown to improve sexual functioning in persons with epilepsy. Specifically, female patients with epilepsy aged 18–45 treated with levetiracetam reported greater satisfaction with their sexual lives when compared to those who were treated with carbamazepine or even healthy controls. The focal epileptic discharges appear to play a role in sexual dysfunction. Daniele et al. reported a reduction of sexual interest in patients with right-sided temporal lobe epilepsy (R-TLE) as compared with left-sided temporal epilepsy (L-TLE) and discussed