Inborn errors of metabolism are quite rare. They are not considered as the main cause of epilepsy. Seizures are often a signal of metabolic disorders. In some cases, treatment with diet or nutritional supplements helps. In order to determine the diagnosis, it is necessary to take into account other signs and syndromes and prescribe additional examinations.
The Yusupov Hospital has all the necessary equipment for an accurate diagnosis and determination of the form of epilepsy.
The use of B vitamins to normalize the functioning of the nervous system among patients with epilepsy
Group B is one of the most common vitamin complexes for preventing the manifestations of epilepsy. The main role of this group is to act as a catalyst for cellular metabolism, which leads to stabilization of the patient’s brain and nervous system.
The most commonly used representatives of the B vitamin group for the treatment of the disease are:
- Riboflafin is one of the most important factors in the formation of red blood cells in the body, therefore it is widely used for the treatment of organs and tissues that are characterized by a high density of blood vessels. This is especially true for brain damage, which includes epileptic seizures.
- One of the main functions of pantothenic acid is considered to provoke the secretion of fatty acids and act as a catalyst for the acetylation process, including the absorption of folic acid, which is one of the most common vitamin elements prescribed for epilepsy.
- The presence of a sufficient amount of folic acid in the body is one of the most important conditions for the development of the circulatory and immune systems, providing the necessary environment for the survival of new cells. The main problem is that the human body cannot produce it on its own, and auxiliary elements are needed for its absorption. Its deficiency is especially acute during tonic-clinical attacks.
Auxiliary elements
For better absorption of the elements described above, it is also recommended to use related substances from the B vitamin group: vitamin H, biotin, carnitine, coenzyme R and vitamin B A to bring folic acid into an active state, it is necessary to absorb a proportional dose of B6.
When is treatment prescribed?
It is traditionally believed that after a single convulsive attack one can refrain from treatment, since the attack may remain the only one in life. In a real-life situation, a doctor may suggest treatment after a single episode if there are strong signs of a high risk of subsequent attacks - e.g.
during a neurological examination in combination with changes in tomograms and electroencephalograms.
Anticonvulsants are prescribed only if it is certain that the patient has epilepsy. If the diagnosis is unclear and the patient feels normal outside the attack, then it is quite acceptable to refrain from treatment and do the necessary examinations, even if the attack recurs. According to modern data, immediate prescription of drugs does not affect the long-term effect of treatment.
Yes, there are several forms of epilepsy with an absolutely favorable prognosis. This primarily applies to rolandic and benign occipital epilepsies. Seizures in children with these forms usually disappear by adolescence. However, this does not mean that they do not need to be treated - attacks can be very severe, even requiring resuscitation.
In some other forms, a favorable outcome with spontaneous recovery is also possible, but it can be extremely difficult to predict.
Features of the use of vitamins E for the regeneration of nerve cells
Tocopherol, or vitamin E, is included in most drug complexes for the treatment of epilepsy and other disorders of the circulatory and nervous system. The most active element of the group is alpha-tocopherol, which is designed to enhance the anticonvulsant effect of other medications and trace elements used to treat the disease.
Also, one cannot fail to mention that tocopherol helps normalize blood flow, which leads to the prevention of pressure surges and anemia, which can provoke an epileptic seizure.
Moreover, tocopherol is prescribed to pregnant women to prevent the development of brain pathologies that can cause the development of epilepsy in the fetus.
Epilepsy: first aid
People who have witnessed an epileptic seizure should know that:
- there is no need to be afraid, this is not a contagious disease;
- no need to fuss and panic, the seizure will soon end on its own;
- there is no need to try to alleviate the patient’s condition or shorten the duration of the attack, it is useless;
- care must be taken to ensure that the patient does not unknowingly harm himself during a seizure.
Procedure:
1. Having seen the beginning of an attack, you need to prevent the patient from falling, otherwise he may get injured. You need to sit the person on a bench or lay him on the ground.
2. After this, you need to sit down next to him and observe the progress of the attack without trying to interfere with it.
3. To prevent injuries to the oral cavity during involuntary muscle contractions, you can place a folded piece of cloth or a handkerchief between the teeth of the epileptic. If your teeth are closed tightly, there is no need to try to unclench them.
4. The patient's head should be tilted to the side so that he does not choke on saliva. If breathing has stopped, then there is no need to panic, it will soon recover.
5. There is no need to prevent convulsions, hold the patient tightly by the limbs, this can lead to injury. It is necessary that there are no objects nearby that a person could hit during an attack.
6. After a seizure, you need to convince the person to lie down for a while to regain strength.
The use of vitamin D in the treatment of epilepsy
Most vitamin and mineral complexes imply possible changes in blood pressure, therefore, in combination with the active elements, a regulator must be prescribed. Most often, D2 (ergocalciferol) is used, much less often D3 (cholecalciferol).
In addition, representatives of group D are designed to absorb calcium and phosphorus, which are necessary for the normal development of the muscular and bone skeleton, as well as strengthening the body's immune system, which are necessary factors for reducing the risks of an epileptic seizure.
It is important to understand that both of the above elements are toxic and have a cumulative effect. An overdose of drugs can have very serious consequences, so the dosage must be strictly regulated by the attending physician, and regular biochemical monitoring is mandatory.
Risks of special children
Autism, epilepsy, cerebral palsy, ADHD and other neurological disorders and developmental problems in children mean a high risk of vitamin D deficiency or deficiency, multiple studies say.
The obvious reason for the increased risk of special children is that they spend longer at home and in rehabilitation facilities than their peers. Because their options are limited, they play and spend less time outdoors.
Taking vitamin D supplements may not be effective in correcting deficiency. The blood and intercellular fluid must contain sufficient cofactors - other vitamins and minerals that help produce and absorb vitamin D. The most important are vitamin K, magnesium, boron, zinc and vitamin A, but the full list of cofactors is wider. Special children often lack several elements at once.
But even if vitamin D and cofactors are supplied in noticeable amounts, a weak liver, inflammatory diseases of the small and large intestines, kidneys, problems with the pancreas and others can interfere with the accumulation of vitamin D.
A common problem that leads to vitamin D deficiency is diet. She may be low in calcium due to dairy intolerance and the popularity of BGBK products. Low levels of calcium in the body trigger a hormonal mechanism for its redistribution. Vitamin D levels decrease to direct calcium into cells. This mechanism is described in detail below.
Although very little vitamin D is supplied through foods, in conditions of deficiency, the importance of this pathway grows. This is where dietary restrictions can also become an obstacle. Not all special children digest fats well and, moreover, regularly eat sea fish.
Treatment and use of medications (such as antiepileptic drugs) can themselves cause vitamin D deficiency due to drug interactions.
Finally, some special needs children experience problems with excess weight due to low mobility. In this case, the retention of vitamin D in fat cells can lead to a decrease in its level in the blood.
Vitamin D deficiency and autism
In one study of Saudi children with autism, their serum 25(OH)D levels were significantly lower (mean 18.5 ng/ml) than healthy controls (33 ng/ml). 40% of children with ASD were deficient in both vitamin D and 48% were deficient in vitamin D. Healthy children were not deficient in vitamin D (20% were deficient). Interestingly, in this study there was no significant difference in sun exposure between children with autism and healthy children. The authors also linked vitamin D deficiency to antibody levels and brain damage, the extent of which may determine the clinical severity of autism.
Two open-label studies found that high doses of vitamin D (300 IU/kg/day) improved core symptoms in approximately 75% of children with autism. Several positive changes were pronounced. It is worth considering here that children with ASD absorb vitamin D less well in the form of supplements, so monitoring its concentration in the blood and dosage adjustment are required.
Vitamin D deficiency and epilepsy
Monitoring and supplementation of vitamin D are important for the treatment of children with epilepsy taking long-term antiepileptic drugs.
Vitamin D deficiency is known to be widespread among patients with seizures. For example, in an American study, only 25% of children with epilepsy had normal vitamin D levels. In another Australian study, 37% of children with epilepsy had normal levels. And these are countries with relatively high average levels of vitamin D in the population.
In a study of 13 patients with drug-resistant epilepsy, their serum vitamin levels were normalized by supplementation. After taking vitamin D3 for 3 months, the number of attacks decreased by an average of 40%.
The risks of deficiency are especially high in children with epilepsy who take AEDs. These are valproate, levetiracetam and anticonvulsants that inhibit liver enzymes. An additional risk factor for deficiency is the combination of epilepsy and developmental delay in children. Also, an increase in the frequency of attacks during winter has been associated with low vitamin D levels.
Reduced bone mass occurs in most people with epilepsy, and 25% of them suffer from osteoporosis. Impaired bone mineralization is associated with additional problems. Seizures themselves pose a risk of injury, including fractures. And decreased bone strength increases this risk. Especially if seizures have serious external manifestations or in children with impaired motor function and coordination.
Vitamin D deficiency and cerebral palsy
The results of a long-term study of Turkish children with cerebral palsy showed a tendency to develop vitamin D deficiency. Only 6.4% of children had a blood level of 25 (OH) D above 30 ng/ml. There is a significant correlation between its level and scores on the GMFCS and MACS scales. Deficiency was more common with concomitant epilepsy, delayed cognitive development, dental problems and growth retardation.
In addition to the tendency for vitamin D deficiency in children with cerebral palsy, an Indian study showed low levels of calcium and high levels of alkaline phosphatase in their blood. The deficiency was most severe in children who were outpatients and receiving antiepileptic drugs.
A study conducted among Iranian children with cerebral palsy confirmed the risks of developing a deficiency. It also showed that the risk increases as children age. One reason is less outdoor activity and therefore less sun exposure.
A Chinese study showed the benefits of vitamin D supplementation for the development of speech function in children with cerebral palsy. Another study showed a significant benefit of vitamin D and calcium supplementation in maintaining bone mineral density in children with cerebral palsy and epilepsy.
Vitamin D deficiency and ADHD
In a Turkish study, children with ADHD, normal intelligence, and no comorbid disorders were compared with a control group. The mean serum vitamin D levels of children with ADHD and controls were 24.1 and 32.71 ng/ml, respectively. However, no significant differences were found in the content of calcium, phosphorus and alkaline phosphatase.
Another study found an inverse association between vitamin D concentrations in newborn umbilical cord blood and ADHD symptoms.
Vitamin D deficiency and headache
Some studies have shown a link between vitamin D deficiency and headaches. The children were divided into groups. The first group includes children with migraines or tension headaches. In the second, control, there were healthy children. Subgroups of children who spent a lot or little time in the sun were also identified. Mean 25(OH)D levels were markedly lower in children with headache compared with controls (17.1 vs. 25.8 ng/mL, respectively). For children who spent a long time in the sun, the difference was 24.6 versus 32.1, and for children who spent little time in the sun, it was 14.5 versus 19.6.
Other vitamins
In the treatment of epilepsy, ascorbic acid (vitamin C) is very often used, which stimulates brain activity and also prevents the formation of free radicals in the body. In addition, a very important function of ascorbic acid is to provoke the production of anti-stress hormones, which eliminates psychological triggers of epileptic seizures.
A mandatory element that should be included in the complex of drugs for the treatment of this disease is biotin (vitamin H). It is used to restore the balance of the gastric environment, as well as to strengthen the nervous system. In addition, biotin significantly accelerates protein synthesis.
Vitamin D and neurological disorders
The effects of vitamin D on brain function include the most important processes: the growth of neurons and synapses, the prevention of neuronal death, and even the regulation of signal transmission. It's no surprise that research supports a link between higher blood concentrations of vitamin D and healthier brain function. Vitamin D deficiency is clinically associated with many neurological, neurodegenerative and psychiatric diseases.
Planning risks
Vitamin D regulates several genes whose proteins repair breaks in DNA or protect it from damage. Therefore, vitamin D deficiency in future parents may be the cause of de novo mutations in the child. Meanwhile, genetic factors play an important role, and sometimes directly become the cause of many neurological disorders - from epilepsy and cerebral palsy to autism.
Risks of pregnancy
Newborn babies are at high risk of vitamin D deficiency. It occurs due to widespread deficiency during the mother's pregnancy. These children are at increased risk of developing a birth-related brain injury. Recent clinical studies have shown that newborns with hypoxic-ischemic brain injury were more likely than healthy children to have vitamin D deficiency.
In addition, vitamin D deficiency leads to changes in the balance of key neurotransmitters and hormones in the brain. Widespread changes affect glutamine and norepinephrine, and regionally selective changes affect dopamine and serotonin. All of them are key to early development. Maternal vitamin D deficiency has been associated with impaired social behavior and autism spectrum disorders.
Conversely, increased prenatal 25(OH)D levels are associated with better cognitive development and a reduced risk of ADHD and autism later in life.
Development risks
In 2021, a detailed article on the effect of vitamin D on synaptic plasticity was published in the authoritative journal Cell. Synapses are branches between neurons that allow them to communicate. Vitamin D is necessary for the formation of the matrix of synapses - connective tissue. The cellular framework provides mechanical support for cells and transport of chemicals, regulates the growth of synapses. In other words, vitamin D is an active participant in regulating the plasticity of the developing brain.
Vitamin D in synaptic plasticity, cognitive function and neuropsychiatric diseases. Cell. Volume 42, Issue 4, P293-306, April 01, 2019
Vitamin D is important not only for brain development, but also for the differentiation, growth and division of body cells in general.
Inflammation and the central nervous system
Vitamin D deficiency aggravates inflammation and keeps it chronic. Meanwhile, epilepsy, autism, and problems with myelination are largely inflammatory diseases.
Vitamin D has many anti-inflammatory effects. It inhibits the release of toxic inflammatory cytokines that damage brain cells and the blood-brain barrier.
In addition, vitamin D ensures an adequate immune response of the body. It helps fight infections by improving the functionality of cells that recognize and destroy pathogens (monocytes, macrophages, dendritic cells and T and B lymphocytes).
Vitamin D and neurotransmitters
Neurotransmitters determine our behavior, mood and activity, and influence brain development. There is growing evidence of the neuroactivity of vitamin D and its ability to regulate multiple pathways of serotonin, dopamine and other neurotransmitters.
Some parents want to better understand how foods and supplements affect their special needs child. They do popular genetic tests (Amy Yasko, 23andme or based on other panels).
These parents and specialists are well aware of the MAO, COMT, SIRT genes, which regulate key neurotransmitters. The activity of these genes appears to be closely related to vitamin D.
For example, vitamin D inhibits the activity of the MAO-A gene, which is known to break down serotonin. Serotonin influences a person's character, controlling appetite, energy expenditure, sleep, temperature, mood and social interaction. Changes in serotonin concentrations in the brain have been linked to autism spectrum disorders and depression. Vitamin D is essential for the precise regulation of serotonin concentrations during signaling.
Vitamin D is also involved in the development of the dopamine system, its functioning and protection against inflammation. For a special child, activity in habilitation and motivation in developmental situations are very important. Dopamine is a neurotransmitter that serves as an important part of the brain's reward system. It creates a feeling of satisfaction and reinforces learning. Poor attention switching, apathy and slow thinking may be associated with a lack of dopamine in some areas of the brain or a disruption in its transmission pathways. An extreme example is Parkinson's disease. Its symptoms are worsened by vitamin D deficiency.
Microelements
Maintaining the balance of vital microelements is important for the prevention of most diseases, including regular epileptic seizures. You can significantly reduce the risk of recurrence of seizures by regularly taking medications containing magnesium and calcium.
It is important to understand that the content of the above elements in the body is periodic. It can sharply decrease due to stressful situations and physical activity, which can lead to the risk of a seizure.
Therefore, the attending physician limits risk factors for a sharp drop in microelement levels and prescribes an individual regimen.
What vitamins should I test for for epilepsy?
A thorough description of clinical manifestations, the results of an examination by a neurologist, as well as laboratory and instrumental examinations helps to determine the causes and nature of an epileptic attack.
Laboratory tests include:
- general blood analysis;
- biochemical blood test - allows you to determine the level of glucose, urea, creatinine, ALT, AST, calcium, potassium, sodium;
- general urine analysis;
- additional examination of the cerebrospinal fluid to exclude or confirm neuroinfection.
