The associations between epilepsy, metabolism, and their clinical implications

Epilepsy can cause metabolic disorders, and metabolic abnormalities can also trigger epilepsy, forming a bidirectional pathological cycle. Over the past century, from the earliest use of ketogenic diets to treat epilepsy, it has been confirmed that metabolic intervention can control seizures. Subsequent studies have gradually revealed that metabolic disorders such as glucose abnormality and vitamin B6 deficiency can directly induce epilepsy, while epileptic seizures themselves can cause lactic acidosis, electrolyte imbalance and other internal environment disorders. With the breakthroughs in metabolomics technology, the research on epilepsy and metabolism has entered a systematic stage, and their relationship has attracted increasing attention. However, current reviews mostly focus on the isolated analysis of a single metabolic element (such as iron, vitamin D), lacking a systematic integration of multiple metabolic elements. This review for the first time integrates the changes of seven major metabolic elements (glucose, lipids, vitamins, minerals, water, adenosine triphosphate, uric acid) in the onset, progression and treatment of epilepsy; summarizes the clinical associations between metabolic diseases (diabetes mellitus, alcoholism, uremia) and epilepsy; reveals the specific metabolic changes in childhood epilepsy; and emphasizes the importance of epilepsy metabolomics data. It provides a reference for basic research and a metabolic monitoring framework for clinicians.