Abstracts

PYRIDOXINE DEFICIENCY IN ADULT STATUS EPILEPTICUS PATIENTS

Abstract number : 3.219
Submission category : 4. Clinical Epilepsy
Year : 2014
Submission ID : 1868667
Source : www.aesnet.org
Presentation date : 12/6/2014 12:00:00 AM
Published date : Sep 29, 2014, 05:33 AM

Authors :
Hina Dave, R. Eugene Ramsay, Fawad Khan, Vivek Sabharwal and Ifeanyi Iwuchukwu

Rationale: A case of an 8 year old girl treated at our facility for super-refractory status epilepticus was found to have a low pyridoxine level at 5 ug/L. After starting pyridoxine supplementation, improvement in the EEG for a 24-hour period was seen. We decided to look at the pyridoxine levels in adult patients admitted with status epilepticus. Methods: With IRB approval, we reviewed the records on patients admitted to the neurological ICU for status epilepticus from January 2014 to June 2014. 15 adult status patients were identified with documented pyridoxine levels. For comparison purposes, we looked at pyridoxine levels in epilepsy outpatients from the past three years. The normal pyridoxine range is 5 to 50 ug/L. Results: In the status population, all but one patient had low normal or undetectable (four patients) pyridoxine levels. 112 adult outpatients were identified. 30% in this group had a low normal pyridoxine level- none of which were undetectable. The mean pyridoxine was 5.60 ug/L in the status group and 23.9 ug/L in the outpatient group. This difference is statistically significant (p < 0.0001 using Fisher's exact test). See Figure 1. Conclusions: Pyridoxine is a water-soluble vitamin that is naturally present in many foods. The active component, pyridoxal 5' phosphate (PLP), binds to intracerebral glutamic acid decarboxylase(GAD) which is the enzyme responsible for the conversion of glutamate to GABA (Figure 2). Without PLP, GABA cannot be synthesized and glutamate remains elevated in the synapse thereby increasing neuronal excitability. GABA deficiency is seen in pyridoxine dependent genetic epilepsy. A number of factors can lower pyridoxine levels including malabsorption, inflammation, kidney disease alcohol dependence, pregnancy, obesity and antiepileptics (valproic acid, dilantin, carbamazepine). GABA is important in seizure suppression, and PLP is crucial for GABA synthesis. Low levels of pyridoxine may make individuals more susceptible to seizure activity and super-refractory status. Pyridoxine deficiency was seen in 46% of status patients (compared to 8% in the outpatients) which leads us to believe that there is a relationship between status epilepticus and pyridoxine levels. The difference in mean pyridoxine level in the status group was statistically significant to the comparison group. Further studies on the effect of pyridoxine on status control are needed.
Clinical Epilepsy