Supplements epilepsy

Fohc acid is safe, even at levels of daily oral supplementation up to 5—10 mg (97). Gastrointestinal upset and an altered sleep pattern have been reported at 15 mg/day (98). A high intake of foHc acid can mask the clinical signs of pernicious anemia which results from vitamin deficiency and recurrence of epilepsy in epileptics treated with dmgs with antifolate activity (99). The acute toxicity (LD q) is approximately 500 and 600 mg per kg body weight for rats and mice, respectively (100). 

Folate supplements will rectify the megaloblastic anemia of vitamin Bj2 deficiency but may hasten the development of the (irreversible) nerve damage found in B,2 deficiency. There is also antagonism between fohc acid and the anticonvulsants used in the treatment of epilepsy. 

All women with epilepsy should take a folic acid supplement, 0.4 to 5 mg daily. 

Pregnancy the exact cause of malformations is difficult to establish as epilepsy itself may cause foetal malformations (neural tube, clef palate...). Folate supplementation is considered to have a preventive effect. 

Another concern in infants of mothers with epilepsy is a serious hemorrhagic disorder that is associated with a high (25-35%) mortality. This probably results from the finding that many AEDs can act as competitive inhibitors of vitamin K-dependent clotting factors. The competitive inhibition can be overcome by the administration of oral vitamin K supplements to the mother during the last week or 10 days of pregnancy. 

I. (1998) L-carnitine supplementation in childhood epilepsy current perspectives. Epilepsia 39 1216-1225. 

Yerby MS (2003) Clinical care of pregnant women with epilepsy neural tube defects and folic acid supplementation. Epilepsia 44 33-40... 

De Vivo DC, Bohan TP, Coulter DL, Dreifuss FE, Greenwood RS, Nordli DR Jr, Shields WD, Stafstrom CE, Tein I. L-carnitine supplementation in childhood epilepsy current perspectives. Epilepsia 1998 39(11) 1216—25. 

Yuen A. W. C., Sander J. W., Fluegel D., Patsalos P. N., Bell G. S., Johnson T., and Koepp M. J. (2005). Omega-3 fatty acid supplementation in patients with chronic epilepsy A randomized trial. Epilepsy Behavior 7 253-258. 

A small fraction of epileptics treated with anticonvulsants dilantin, phenytoin, diphenylhydantoin) develop folate deficiency. Epilepsy is not a rare disease. Hence, there is an awareness of the possibility of the occurrence of megaloblastic anemia in epileptics treated with the aforementioned anticonvulsant. Supplementing epileptics with folate can alleviate the deficiency however, the supplements may also result in an increase in Ihe seizure rate. Thus, physicians must be prepared to halt folate supplementation of epileptics beuig treated for anemia. 

However, potential therapeutic interventions require randomized prospective studies. Variables that might be addressed in such trials include the impact of monotherapy and polytherapy on the attainment of peak bone mass in adolescence and adulthood bone health in women characterization of the impact of limitations in physical activity on bone density in patients with epilepsy who have cerebral palsy or those with developmental disabilities or mental retardation the effects of newer antiepileptic drugs on bone metabolism standardization of the workup for bone disease in patients with epilepsy and the effectiveness of the current recommendations for supplementation with calcium and vitamin D. 

Mood Disorders. The brain is reported to receive a priority supply of selenium during dietary depletion and/or repletion studies in animals and the turnover of neurotransmitters is altered. This has led to extensive studies of the role of selenium and other antioxidants in senility of the elderly, in epilepsy in children, and in Alzheimer s disease. Marginal selenium depletion has been associated with anxiety, confusion, and hostility, and improvements have been claimed following supplementation." ... 

Little is known regarding the effect of menopause on epilepsy. The perimenopausal period may be associated with worsening of seizures, possibly owing to fluctuations in sex hormones. At menopause, seizures actually may improve, particularly in women who previously presented with a catamenial pattern. The effect of hormone-replacement therapy on seizure control is still unclear, but clinicians should monitor for seizure exacerbation in women receiving supplemental estrogen. 

Gidal BE, Inglese CM, Meyer JM, et al. Diet and valproate mediated transient hyperammonemia Effect of 1-carnitine supplementation in children with epilepsy. Pediatr Neurol 1997 16 301-305. 

If drug withdrawal is planned, it should be attempted at least 6 months before conception is attempted. In addition, all women with epilepsy should take folic acid supplementation of 0.4 to 5 mg daily. To correct vitamin K deficiency in newborns, 10 mg oral vitamin Ki should be supplemented daUy in the mother during the last month of gestation. ... 

Critchfield JW, Carl GF, Keen CL. 1993. The influence of manganese supplementation on seizure onset and severity, brain monoamines in the genetically epilepsy prone rat. Epilepsy Res. 14 3-10. 

The antiseizure drugs introduced after 1990 have teratogenic effects in animals but whether such effects occur in humans is uncertain. One consideration for a woman with epilepsy who wishes to become pregnant is a trial period without antiseizure medication monotherapy with careful attention to drug levels is another alternative. Polytherapy with toxic levels should be avoided. Folate supplementation (0.4 mg/day) is recommended for all women of childbearing age to reduce the likelihood of neural tube defects, and this is appropriate for epileptic women as well. 

Other conditions of possible but unclear relation myotonic dystrophy, epilepsy, various drugs/supplements, schizophrenia and sleep apnea... 

In a few studies, the protective effect of folic acid among pregnant women on AEDs has been assessed. A possible but small reduction in congenital malformations with folic acid supplements has been reported (Hill et al. 2010). It appears that most of the teratogenic effects of AEDs are via other mechanism than low folate. Despite the modest protective effect of folate supplements, it is still recommended in women with epilepsy. 

Folate deficiency usually takes 3-5 years to evolve in patients with epilepsy. Therefore, prophylactic B vitamin supplements may be recommended for patients at risk. As long as physiological doses are used, vitamin therapy should be safe. 

In general, women of childbearing potential are encouraged to take 0.4 mg of folic acid per day, with the dose increased to 4 mg per day for high-risk women. The recommendation of 0.4 mg folic acid per day applies to most fertile women on AEDs. Four mg per day is recommended for women on inducer AEDs and VPA. However, there is sparse evidence that favour high doses of folic acid. Some reports suggest that supplementation with low-dose folic acid i.e. <0.4 mg) may be sufficient for normalizing homocysteine metabolism in epilepsy (Apeland et al. 2002). 

It appears reasonable to recommend supplementation with several B vitamins in physiological doses to many patients with epilepsy. Patients on inducer AEDs and VPA, and patients with an insufficient diet, are at risk for deficiency of several B vitamins. Moreover, the evidence that folic acid can prevent adverse effects in patients on AEDs is not much higher than the evidence for a protective effect of vitamins B2, Bg, B7 and B12 (Ranganathan and Ramar-atnam 2005). In animal studies, deficiency of vitamins B2 and Bg has been related to the occurrence of foetal malformations. Therefore, women of childbearing potential should supplement their diet with vitamin B2 and Bg, as well as folic acid. 

Many patients with epilepsy should take prophylactic B vitamin supplements in physiologic doses (multivitamins). 

A 35-year-old woman taking valproate 500 mg bd and phenobarbital 75 m day for idiopathic generalized epilepsy who had been seizure-free for 3 years had a recurrence of myoclonic jerks, absences, and a tonic-clonic seizure a few days after taking a dietary supplementation that contained chitosan 500 mg bd for weight loss. The seizures remitted after chitosan was stopped. Three months later she restarted chitosan and within 5 days once more had seizures. Semm valproate was undetectable. Chitosan was withdrawn, the seizures remitted, and the valproate concentration returned to baseline (50 mg/1) within 4 days. 

Major P, Greenberg E, Khan A, Thiele EA. Pyridoxine supplementation for the treatment of levetiracetam-induced behavior side effects in children preliminary results. Epilepsy Behav 2008 13(3) 557-9. 

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