Extreme ambient temperatures and seizure outcomes in children with epilepsy: insights from a survey in Turkey

Climate change is a global crisis with profound social, psychological, and economic consequences, and it poses significant risks to human health including for neurological diseases. Children with epilepsy represent a particularly vulnerable population, as they may be more susceptible to the adverse effects of extreme temperatures. This project aims to determine the perceptions of heat-related seizure impacts for a population of children with epilepsy (CWE) and focuses particularly on the July-2024 heatwave experienced in Turkey.

We conducted a face-to-face survey (n = 151, October 2024-March 2025). The 32-question survey included demographic characteristics, and effects of extreme temperatures, which are defined as temperatures beyond typical seasonal ranges, above the 95th percentile for heat and below the 5th-10th percentile for cold, on seizures. Sex, pharmacological treatment, genetic diagnosis, and immobility were evaluated as risk factors. Statistical Package for the Social Sciences (SPSS.24) was used for Chi-square test, Fisher's exact test, and Mann-Whitney U test. P < 0.05 was considered significant.

For any period of extremely hot or cold temperatures, 33.8% of patients (n = 51) reported changes in their seizure characteristics, while 21.2% (n = 32) required hospital admission due to seizures. These effects were more common in males (41.9%, n = 36) than females (23.1%, n = 15) (p = 0.016). Children on carbamazepine monotherapy (n = 6) were more affected (66.7%) compared to those on levetiracetam (15.6%, n = 5) or valproate (38.9%, n = 7) (p = 0.009). During the five-day July-2024 heatwave, 18.5% (n = 28) reported seizure worsening; 26.6% on polytherapy, 10.9% on monotherapy, and none without medications (n = 8) (p = 0.023). Of these affected CWE, 28.6% (n = 8) had genetic epilepsy, 25% (n = 7) were unambulatory, 11.9% (n = 18) visited the emergency department and 5% (n = 7) had difficulty in accessing medications.

Extreme heat was associated with caregiver- and patient-reported seizure worsening in CWE. Male sex and carbamazepine were associated with seizure worsening. Further research is needed to clarify genetic impacts. These findings highlight the need to develop adaptation strategies to preserve quality of life of CWE during extreme temperatures.