Epileptic Adolescents and Ramadan Fasting: A Prospective Cohort Study

Abstract

This study aimed to evaluate the effect of Ramadan fasting on seizure control in epileptic adolescents. A prospective cohort study that included 56 epileptic patients aged 11 to 18 years. Patients were followed-up in the pediatric neurology clinic at Tanta University Children's Hospital during Ramadan 2019. Seizures frequency and severity, measured by Chalfont seizure severity scale, during Ramadan fasting were compared with those in the month before Ramadan. Before Ramadan, 43/56 patients were controlled and seizure free. Meanwhile, 13/56 patients were uncontrolled and had seizure frequency of one to six seizures in the month before Ramadan. There was no significant difference in seizure frequency during Ramadan compared with before Ramadan (p = 0.132), whereas seizure severity was significantly reduced during Ramadan (p = 0.028). Both seizure frequency and severity were significantly lower during Ramadan in uncontrolled epileptic patients compared with before Ramadan (p = 0.02 and 0.005). Ramadan fasting is safe in adolescents with epilepsy. Fasting is not a precipitating factor for seizures in epileptic adolescents, provided compliance to antiepileptic drugs, and could be beneficial for seizure control in uncontrolled epilepsy.

Keywords

seizure control - fasting - epilepsy

Publication History

Received: 15 April 2020

Accepted: 16 September 2020

Article published online:
26 October 2020

• References

• 1 Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord 2015; 17 (02) 117-123
• 2 Benamer HTS, Grosset DG. A systematic review of the epidemiology of epilepsy in Arab countries. Epilepsia 2009; 50 (10) 2301-2304
• 3 Alshahawy AK, Darwish AH, Elsaid Shalaby S, Mawlana W. Prevalence of idiopathic epilepsy among school children in Gharbia Governorate, Egypt. Brain Dev 2018; 40 (04) 278-286
• 4 Gomceli YB, Kutlu G, Cavdar L, Inan LE. Does the seizure frequency increase in Ramadan?. Seizure 2008; 17 (08) 671-676
• 5 Fisher RS, Acevedo C, Arzimanoglou A. et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014; 55 (04) 475-482
• 6 Berg AT, Berkovic SF, Brodie MJ. et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia 2010; 51 (04) 676-685
• 7 Scheffer IE, Berkovic S, Capovilla G. et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58 (04) 512-521
• 8 Kwan P, Arzimanoglou A, Berg AT. et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2010; 51 (06) 1069-1077
• 9 Grinnon ST, Miller K, Marler JR. et al. National Institute of Neurological Disorders and Stroke Common Data Element Project - approach and methods. Clin Trials 2012; 9 (03) 322-329
• 10 Duncan JS, Sander JW. The Chalfont Seizure Severity Scale. J Neurol Neurosurg Psychiatry 1991; 54 (10) 873-876
• 11 Al-Mahdawi AM. Epilepsy and Ramadan fasting. Neurosciences (Riyadh) 2002; 7 (03) 207-209
• 12 Lennox WG, Cobb S. Studies in Epilepsy. VIII. The Clinical Effect of Fasting. Arch Neurol Psychiatry 1928; 20: 771-779
• 13 Geyelin HR. Fasting as a method for treating epilepsy. Med Rec 1921; 99: 1037-1039
• 14 Freeman JM, Vining EP. Seizures decrease rapidly after fasting: preliminary studies of the ketogenic diet. Arch Pediatr Adolesc Med 1999; 153 (09) 946-949
• 15 Hartman AL, Rubenstein JE, Kossoff EH. Intermittent fasting: a “new” historical strategy for controlling seizures?. Epilepsy Res 2013; 104 (03) 275-279
• 16 Sharma S, Kaur G. Neuroprotective potential of dietary restriction against kainate-induced excitotoxicity in adult male Wistar rats. Brain Res Bull 2005; 67 (06) 482-491
• 17 Duan W, Guo Z, Mattson MP. Brain-derived neurotrophic factor mediates an excitoprotective effect of dietary restriction in mice. J Neurochem 2001; 76 (02) 619-626
• 18 Kauwe G, Tsurudome K, Penney J. et al. Acute fasting regulates retrograde synaptic enhancement through a 4E-BP-dependent mechanism. Neuron 2016; 92 (06) 1204-1212
• 19 Ferrarelli LK. Fasting, translation control, and seizures. Sci Signal 2017; 10 (460) eaam6552
• 20 Fedorovich SV, Waseem TV. Metabolic regulation of synaptic activity. Rev Neurosci 2018; 29 (08) 825-835
• 21 Fedorovich SV, Voronina PP, Waseem TV. Ketogenic diet versus ketoacidosis: what determines the influence of ketone bodies on neurons?. Neural Regen Res 2018; 13 (12) 2060-2063
• 22 Bailey EE, Pfeifer HH, Thiele EA. The use of diet in the treatment of epilepsy. Epilepsy Behav 2005; 6 (01) 4-8
• 23 Gano LB, Patel M, Rho JM. Ketogenic diets, mitochondria, and neurological diseases. J Lipid Res 2014; 55 (11) 2211-2228
• 24 Siniscalchi A. Treatment of epilepsy in the elderly people. BMC Geriatr 2010; 10: L47
• 25 Tamez-Peña AL, Tamez-Pérez HE, Peña-Lazo A, Ocampo-Candiani J. Torres- Pérez JF. Use of medications on the elderly. Medicina Universitaria 2014; 16: 199-206