Impact of Ramadan Intermittent fasting on patients with epilepsy: A clinical and laboratory study

To assess the changes in seizures frequency and key physiological blood parameters in Muslim patients with epilepsy upon the observance of Ramadan fasting.

This prospective cohort study was carried out at the Neurology Department of the Faculty of Medicine, Mansoura University, Egypt. The study involved monitoring the same group of patients over three distinct periods: pre-Ramadan (Shaaban), during Ramadan, and post-Ramadan (Shawal), to track seizure frequency. The study involved 20 adult Muslim patients with epilepsy who observed fasting during Ramadan with equal distribution between male (n = 10) and female (n = 10) participants and mean age of 39.2 ± 9. Demographic and clinical characteristics were documented. Laboratory measurements, including hematocrit, sodium, potassium, and beta-hydroxybutyrate levels, were recorded during both fasting and non-fasting periods (Ramadan and Shawaal).

Nearly one-third of participants remained seizure-free throughout Ramadan (n = 7). Patients who experienced seizures during Ramadan had significantly poorer seizure control during the six months leading up to Ramadan (P-value = 0.003). Prolonged fasting periods were linked to increased seizure risk (P-value = 0.02). Also, Patients on polytherapy were more likely to have seizures during Ramadan fasting compared to those on monotherapy or dual therapy (P-value = 0.03). Blood beta-hydroxybutyrate, sodium and hematocrit levels were significantly higher during the fasting period in Ramadan compared to the post-Ramadan non-fasting period in Shawaal (P-value; <0.001, <0.001, = 0.01, respectively). These differences did not show a significant impact on seizure status during Ramadan (based on Mann-Whitney test, P- value = 0.1, 0.5, 0.4 respectively). Potassium levels remained stable between Ramadan and Shawaal (P-value = 0.4). However, Patients with higher potassium levels were significantly noticed to experience seizures during Ramadan (P-value = 0.005).

Fasting during Ramadan may be associated with increased risk of seizures in patients with poorly controlled epilepsy, especially those on polytherapy and long fasting period. Changes in hydration status and electrolyte levels during fasting may have a role in influencing seizure status.