Sexual outcome after epilepsy surgery

doi:10.1016/S1525-5050(03)00085-4

Epilepsy & Behavior

Volume 4, Issue 3, June 2003, Pages 268-278

https://doi.org/10.1016/S1525-5050(03)00085-4 Get rights and content

Abstract

The aim of this study was to provide a description of patient-perceived sexual change after temporal lobe resection (TLR) and extratemporal resection (ETR). Fifty-eight TLR and sixteen ETR patients completed a semistructured interview and questionnaire assessing sexual change after epilepsy surgery. Five areas of sexual functioning were addressed: sexual drive, thoughts/fantasies, interest, masturbation, and activity. Each patient’s perception of sexual changes relative to perceived levels of normal functioning was assessed. Characteristically, the onset of sexual change occurred in the first three postoperative months and persisted to the time of interview. A postoperative sexual change was significantly more likely to be reported by patients who had undergone TLR (64%) than ETR (25%). In the TLR group, sexual change was significantly more frequent following right-sided resections. Marked sexual change occurred more frequently in females than males. Postoperative sexual change is an important outcome feature after epilepsy surgery. The predisposition of TLR patients to postoperative change provides further evidence for a temporal lobe contribution to sexual function.

Introduction

Chronic epilepsy has a broad range of psychosocial effects, including changes in sexual function [1], [2], [3]. Surgical treatment of chronic epilepsy has a further impact on psychosocial adjustment [4], [5], [6], [7]. Some patients report marked changes in sexual function after epilepsy surgery [4], [6], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]. Despite the significance of sexuality in daily life, research on sexual outcome after epilepsy surgery is limited.

Previous studies have dealt with single cases [8], [9], [19] or small numbers of patients [14], [17], have predated the era of modern neuroimaging, and have not documented the phenomenology of postoperative sexual changes in any detail [10], [11]. With one exception [20], previous studies have focused exclusively on patients undergoing temporal lobectomy. We set out to examine the effects of epilepsy surgery on sexual function by obtaining detailed qualitative and quantitative description of patient-perceived sexual change after temporal lobe and extratemporal resection.

Section snippets

Subjects

All participants had undergone epilepsy surgery within the Comprehensive Epilepsy Program (CEP) at the Austin & Repatriation Medical Centre (A&RMC) between August 1995 and May 2001. Our preoperative protocol and surgical approach has been described previously [22]. Information used to characterize the sample was collected during presurgical evaluation and included a neurological and seizure history, psychiatric evaluation using DSM-IV (1994) criteria, and the results of standard

Procedure

Patients were recruited for this study through the Seizure Surgery Follow-up and Rehabilitation Program of the A&RMC [24]. As part of their routine clinical management, all patients undergoing surgery were assessed preoperatively and were followed-up at regular intervals for a minimum of 2 years postoperatively [24]. Informed consent was obtained from the participants and the study was approved by the Human Research Ethics Committee of the A&RMC. Patients completed the semistructured interview

Patient perceptions of normal sexual functioning

The majority of TLR and ETR patients regarded the “normal” frequency of sexual activity and drive as “once to a few times a week” (see Table 3). A normal frequency of sexual thoughts/fantasies was also considered “once to a few times a week” by 36% of TLR and 43% of ETR patients. A normal frequency of masturbation was considered to be “once a month or less” by 36% of TLR patients and “not at all” by 43% of ETR patients (see Table 3). There were no significant differences between the temporal

Discussion

We have provided a description of patient-perceived sexual change after epilepsy surgery. Typically, sexual function increased to a level of “normal” functioning as perceived by the patient group in the areas of sexual drive, activity, thoughts/fantasies, and masturbation. In a smaller number of patients sexual function increased or decreased to a level above or below patient-perceived normality. Characteristically, the onset of sexual change occurred in the first 3 postoperative months and

Acknowledgements

The authors acknowledge staff and patients of the Comprehensive Epilepsy Program at the A&RMC, and in particular Professor Samuel F. Berkovic, Director of the Program, for his invaluable advice and support. This paper has been partly supported by ongoing funding from GlaxoSmithKline, Australia.

References (54)

P.F Bladin et al.
Outcome assessment in seizure surgery: the role of postoperative adjustment
J. Clin. Neurosci.
(1999)
W Mitchell et al.
Epilepsy with fetishism relieved by temporal lobectomy
Lancet
(1954)
M.A Falconer et al.
Treatment of temporal lobe epilepsy by temporal lobectomy: a survey of findings and results
Lancet
(1955)
A.D Baird et al.
Hypersexuality after temporal lobe resection
Epilepsy Behav.
(2002)
S.J Wilson et al.
Outcome of temporal lobectomy: expectations and the prediction of perceived success
Epilepsy Res.
(1999)
A Daniele et al.
Sexual behavior and hemispheric laterality of the focus in patients with temporal lobe epilepsy
Biol. Psychiatry
(1997)
M Nishizuka et al.
Organisational action of estrogen on synaptic pattern in the amygdala: implications for sexual differentiation of the brain
Brain Res.
(1981)
M Nishizuka et al.
Sexual dimorphism in synaptic organization in the amygdala and its dependence on neonatal hormone environment
Brain Res.
(1981)
Y Arimatsu et al.
Sexual dimorphism in α-bungarotoxin binding capacity in the mouse amygdala
Brain Res.
(1981)
M.S Franklin et al.
Gender differences in brain volume and size of corpus callosum and amygdala of rhesus monkey measured from MRI images
Brain Res.
(2000)

G.M Murphy

The human medial amygdaloid nucleus: no evidence for sexual difference in volume

Brain Res.

(1986)

J Lindsay et al.

Long-term outcome in children with temporal lobe seizures. II. Marriage, parenthood and sexual indifference

Dev. Med. Child. Neurol.

(1979)

M Morrell

Sexual dysfunction in epilepsy

Epilepsia

(1991)

B Toone

Epilepsy and sexual life

P.F Bladin

Psychosocial difficulties and outcome after temporal lobectomy

Epilepsia

(1992)

S.J Wilson et al.

The ‘burden of normality’: concepts of adjustment after seizure surgery

J. Neurol. Neurosurg. Psychiatry

(2001)

S.J Wilson et al.

The longitudinal course of adjustment after seizure surgery

Seizure

(2000)

R Hunter et al.

Temporal lobe epilepsy supervening on longstanding transvestism and fetishism

Epilepsia

(1963)

I Jensen et al.

Mental aspects of temporal lobe epilepsy: follow-up of 74 patients after resection of a temporal lobe

J. Neurol. Neurosurg. Psychiatry

(1979)

R.J Savard et al.

Changes in social functioning after surgical treatment for temporal lobe epilepsy

Soc. Work

(1965)

A.E Walker

The libidinous temporal lobe

Arch. Suisses Neurol. Neurochir. Psychiatrie

(1972)

D Blumer et al.

Sexual behaviour in temporal lobe epilepsy: a study of the effects of temporal lobectomy on sexual behavior

Arch. Neurol.

(1967)

D Hill et al.

Personality changes following temporal lobectomy for epilepsy

J. Ment. Sci.

(1957)

D Blumer

Hypersexual episodes in temporal lobe epilepsy

Am. J. Psychiatry

(1970)

D Blumer

Changes in sexual behavior related to temporal lobe disorder in man

J. Sex Res.

(1970)

P.H Cogen et al.

Reproductive function in temporal lobe epilepsy: the effect of temporal lobectomy

Surg. Neurol.

(1979)

J.A Anson et al.

Post ictal Kluver Bucy syndrome after temporal lobectomy

J. Neurol. Neurosurg. Psychiatry

(1993)

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Regarding the potential impact of epilepsy surgery on male infertility, Bauer et al. [111] examined 22 men who underwent successful surgery for TLE and reported post-operation sex hormone level normalization. Epilepsy surgery has been shown to have a beneficial effect on sexuality especially in seizure-free men [51], although no restoration of sexual function after anterior temporal lobectomy has been reported, regardless of patients’ outcome and seizures freedom [112]. Polytherapy has been associated with delayed gonadal maturation and hormonal profile disturbances in young boys with epilepsy [113].
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View full text

Sexual outcome after epilepsy surgery

Abstract

Introduction

Section snippets

Subjects

Procedure

Patient perceptions of normal sexual functioning

Discussion

Acknowledgements

J. Clin. Neurosci.

Lancet

Lancet

Epilepsy Behav.

Epilepsy Res.

Biol. Psychiatry

Brain Res.

Brain Res.

Brain Res.

Brain Res.

Brain Res.

Long-term outcome in children with temporal lobe seizures. II. Marriage, parenthood and sexual indifference

Dev. Med. Child. Neurol.

Sexual dysfunction in epilepsy

Epilepsia

Epilepsy and sexual life

Psychosocial difficulties and outcome after temporal lobectomy

Epilepsia

The ‘burden of normality’: concepts of adjustment after seizure surgery

J. Neurol. Neurosurg. Psychiatry

The longitudinal course of adjustment after seizure surgery

Seizure

Temporal lobe epilepsy supervening on longstanding transvestism and fetishism

Epilepsia

Mental aspects of temporal lobe epilepsy: follow-up of 74 patients after resection of a temporal lobe

J. Neurol. Neurosurg. Psychiatry

Changes in social functioning after surgical treatment for temporal lobe epilepsy

Soc. Work

The libidinous temporal lobe

Arch. Suisses Neurol. Neurochir. Psychiatrie

Sexual behaviour in temporal lobe epilepsy: a study of the effects of temporal lobectomy on sexual behavior

Arch. Neurol.

Personality changes following temporal lobectomy for epilepsy

J. Ment. Sci.

Hypersexual episodes in temporal lobe epilepsy

Am. J. Psychiatry

Changes in sexual behavior related to temporal lobe disorder in man

J. Sex Res.

Reproductive function in temporal lobe epilepsy: the effect of temporal lobectomy

Surg. Neurol.

Post ictal Kluver Bucy syndrome after temporal lobectomy

J. Neurol. Neurosurg. Psychiatry