Authors :
Presenting Author: Fahad alhargan, MBBS – King Abdulaziz Medical City
Ali Al Anazi, MBBS – King Abdulaziz Medical City
Ashwaq AlShahrani, MBBS – King Faisal Medical City
Aliah Gadah, MBBS – King Abdulaziz Medical City
Abdulazizi Allhybi, MBBS – King Abdulaziz Medical City
Mohammed Alsayari, MBBS – King Saud bin Abdulaziz University for Health Sciences
Rationale:
Epilepsy affects approximately 50 million people globally. Seizure frequency and management can be impacted by lifestyle factors such as fasting, sleep disruption, and medication adherence. Ramadan involves significant lifestyle changes, including fasting from dawn to sunset, altered sleep schedules, and potential medication timing adjustments, which could affect seizure control. Limited research, often with methodological biases, has explored the impact of Ramadan fasting on seizure frequency. This study aimed to determine the effect of Ramadan fasting on emergency room (ER) visits due to breakthrough seizures among epilepsy patients.
Methods:
We conducted a single-center, retrospective chart review at King Abdulaziz Medical City, Riyadh, Saudi Arabia, analyzing ER visits for breakthrough seizures from January 2016 to December 2023. Eligible participants included mentally competent epilepsy patients aged ≥ 14 years actively taking anti-seizure medications (ASMs). Patients who presented during Ramadan were compared to those presenting during Shaaban (preceding month) and Shawwal (following month). Exclusion criteria were cognitive impairments or repeated ER visits. Chi-square and ANOVA tests were used to assess differences between groups.
Results:
A total of 288 epilepsy patients visited the ER with breakthrough seizures, with a median age of 32 years. There was no statistically significant difference in ER visits during Ramadan compared to Shaaban and Shawwal. Status epilepticus occurred in 48 patients, with 15 episodes during Ramadan. The leading seizure triggers identified were ASM non-compliance (36.8%) and sleep deprivation (15%). Hospital admissions were required in 57 cases (19.8%), including five intensive care unit (ICU) admissions.
Conclusions:
In this large retrospective analysis, Ramadan fasting did not significantly increase ER visits due to breakthrough seizures compared to adjacent non-fasting months. However, clinicians should remain aware of potential risks related to fasting-induced lifestyle changes, including medication timing, adherence, and sleep disturbances. The limitations inherent to retrospective designs and potential underreporting of seizure frequency were noted. This suggests the need for prospective, controlled studies. Future research should explore the effects of fasting on medication metabolism, seizure frequency, and patient adherence, ultimately enabling healthcare providers to deliver informed counseling and individualized patient care during Ramadan.
Funding:
Funding: No external funding was received for this study.