Drugs 2003; 63 (12): 1185-1227 REVIEW ARTICLE 0012-6667/03/0012-1185/$33.00/0 © Adis Data Information BV 2003. All rights reserved. Polycystic Ovary Syndrome and Epilepsy A Review of the Evidence Roberta Meo 1 and Leonilda Bilo 2 1 Neurology Outpatients Service, ASL NA1, Naples, Italy 2 Department of Neurological Sciences, Epilepsy Center, ‘Federico II’ University, Naples, Italy Contents Abstract ................................................................................... 1185 1. Polycystic Ovary Syndrome (PCOS): Still a Matter of Debate? ............................... 1186 2. PCOS in Women with Seizures: the Epilepsy Theory ......................................... 1188 3. PCOS in Women with Seizures: the Valproic Acid (VPA) Theory .............................. 1191 3.1 Studies on Prevalence ............................................................... 1192 3.2 Studies on Adolescent Patients ....................................................... 1196 3.3 Studies on Selected Groups of Patients ............................................... 1196 3.4 Studies Focusing on Hyperinsulinism, Insulin Resistance Syndrome and Increased Cardiovascular Risk ................................................................. 1200 4. Polycystic Ovary Syndrome in Women with Seizures: Other Voices ........................... 1202 5. Polycystic Ovary Syndrome in Non-Epileptic Women Treated with VPA: Settling the Controversy? ........................................................................... 1210 6. Conclusions ............................................................................ 1213 6.1 Is There an Increased Prevalence of PCOS in Women with Epilepsy? Is this Related to the Use of VPA? ........................................................................ 1219 6.2 Suggested Guidelines in Clinical Practice ............................................. 1222 Overrepresentation of polycystic ovary syndrome (PCOS) in women with Abstract epilepsy has been described since the early 1980s. While some authors attribute this association to an effect of the seizure disorder on the hypothalamic control of reproductive function, others have reported a relationship with the use of the antiepileptic drug valproic acid (VPA). In this article we review the literature on this complex issue, with a detailed analysis of the different reports which describe the reproductive endocrine assessment in women with epilepsy. In spite of the large number of patients assessed, a clear picture does not emerge, mostly because of the wide variability of methodology employed in the different study projects and of the small size of many patient samples especially when divided in subgroups. However, on the whole these studies suggest that women with epilep- sy are at risk for developing reproductive endocrine disorders, even if there is not yet definite evidence that PCOS may be over-represented in these patients nor that VPA may be the cause of endocrine problems. It is likely that both the epileptic disorder and the antiepileptic treatment play different roles in the development of such disturbances. This hypothesis deserves further prospective study in large