Impact of Ramadan on seizure-related emergency department visits in Qatar

Whether Ramadan fasting influences seizure occurrence or severity is an important clinical question for Muslim patients with epilepsy. Prior studies are limited and show conflicting results.

We conducted a retrospective observational study of all seizure-related emergency department (ED) visits in Hamad Medical Corporation hospitals (Qatar) during Ramadan and the adjacent month before and after, over 2021-2023. Patient data (demographics, seizure features, outcomes, and management) were collected. We compared Ramadan versus non-Ramadan periods, including subgroup analyses for first-time seizures and known epileptic patients. Additionally, an age- and sex-matched case-control analysis (n = 142) was performed, matching fasting Ramadan cases to non-Ramadan controls.

Among 1492 seizure-related ED visits (470 during Ramadan; 1022 in combined non-Ramadan months), the proportion of total ED visits due to seizures was similar during and outside Ramadan (0.8%). No significant differences were found in clinical severity markers (rates of status epilepticus, seizure clustering, hospital admissions, ICU admissions, or 72-hour revisits) between Ramadan and non-Ramadan periods (all p > 0.05). In the matched case-control subset, fasting patients were more likely to receive intravenous antiseizure medication loading in the ED (40.0% vs 18.3%, p = 0.005). Fasting patients with history of epilepsy had a higher rate of prior good seizure control (69.8% vs 32.7%, p < 0.001) and were less likely to be started on new antiseizure medication (5.7% vs 20.4%, p = 0.026).

Ramadan was not associated with increased seizure-related ED burden. Emergency physicians modified acute management for fasting subjects by favouring intravenous antiseizure medication loading and deferring new oral regimen initiation.