Seizures in eating disorders

To complete a descriptive study of seizure etiology in a large population of eating disorder (ED) patients and to better understand whether malnutrition itself, in those with EDs, is associated with seizure development.

In this retrospective study, 75 patients with documented seizures met inclusion criteria from a total of 1664 charts.

Prevalence of seizures in this ED cohort was found to be 4.5%, with 29.3% of individuals experiencing seizures due to psychogenic nonepileptic seizures (PNES). Other common causes of seizures included substance abuse/withdrawal (18.7%), primary seizure disorder (12%), and electrolyte abnormalities/hypoglycemia (10.7%). Three patients (4%) also developed their seizures presumably due to Wernicke's encephalopathy (WE).

Several etiologies of seizures are reported from this large sample of ED patients, and this is also the first study to report on a possible association of WE as a cause of seizures in ED patients. The contribution of WE and malnutrition toward the development of seizures in this population remains to be determined, and future studies should also seek to better understand the inter-relationship between malnutrition and the other variables discussed in this article, such as hypomagnesemia, toward seizure development.

The medical complications of EDs are myriad but seizures have not historically been considered one of those direct complications of malnutrition. The findings of this retrospective study suggest that seizure development may be a direct and indirect complication associated with EDs. The presentation of Wernicke's encephalopathy, which can also be associated with development of seizures, requires further investigation in those with EDs.