Overview Epileptic children and Vitamin D

Fact: Anti-epilepsy drugs lower vitamin D levels
Fact: Epilepsy 5X more likely if preterm birth (low vitamin D)
Fact: Preterm greatly decreased if add vitamin D and/or Omega-3
Fact: Vitamin D supplementation increases Vitamin D levels
Recommendation: Epileptics should take vitamin D to:
    Reduce the number of seizures (restore vitamin D then take a maintenance dose of at least 5,000 IU daily)
   Avoid having health problems associated with low vitamin D, such as low bone density
1 study: Epileptics have low vitamin D levels before starting treatment
Epilepsy = 4,000 years of ignorance, superstition and stigma
   followed by 100 years of knowledge, superstition and stigma.

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17 items in Epilepsy category

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• Diseases that may be related via low vitamin D
• Interactions with Vitamin D category listing has 125 items along with related searches
• CBD benefits - review of literature April 2019

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Epilepsy seizures reduced by daily 1,000 IU of Vitamin D (added to monotherapy) - RCT Sept 2024

Vitamin D Supplementation for Children with Epilepsy on Antiseizure Medications: A Randomized Controlled Trial
Children 2024, 11(10), 1187; https://doi.org/10.3390/children11101187
by Fahad A. Bashiri 1,2,*,†ORCID,Abrar Hudairi 1,2ORCID,Muddathir H. Hamad 1,2,Lujain K. Al-Sulimani 3,Doua Al Homyani 3,Dimah Al

Background: Antiseizure medications (ASMs) are crucial for managing epilepsy in children. However, a well-documented side effect of ASMs is their impact on bone health, often due to interference with vitamin D metabolism. This can lead to vitamin D deficiency in children with epilepsy. This study aimed to determine if a daily dose of 400 IU or 1000 IU would maintain adequate vitamin D levels in children with epilepsy.

Methods: A phase IV randomized controlled trial enrolled children aged 2–16 years with epilepsy and receiving antiseizure medications. Children were divided into two groups: the monotherapy group, which was defined as children on one antiseizure medication (ASM), and the polytherapy group, which was defined as children receiving two or more ASMs. Eligible children with levels above 75 nmol/L were randomized to receive a maintenance dose of either 400 IU/day or 1000 IU/day of cholecalciferol. Baseline and 6-month assessments included demographic data, anthropometric measurements, seizure type, medications, seizure control, and 25(OH)D level.

Results: Out of 163 children, 90 were on monotherapy and 25 on polytherapy. After 6 months of vitamin D maintenance, the proportion of children with 25(OH)D concentration below 75 nmol/L was 75.0% in the 400 IU group and 54.8% in the 1000 IU group. In the monotherapy group, baseline seizure-free children increased from 69% to 83.6% after treating vitamin D deficiency.

Conclusion: Daily vitamin D supplementation with 1000 IU may be beneficial for children with epilepsy, particularly those receiving monotherapy, to maintain sufficiency and potentially improve seizure control.
 Download the PDF from VitaminDWiki

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Poor vitamin D genes can result in juvenile absence epilepsy - May 2023

The causal effect of serum 25-hydroxyvitamin D levels on epilepsy: A two-sample Mendelian randomization study
Epilepsia Open . 2023 May 9. doi: 10.1002/epi4.12758 PDF is behind a paywall
Xinxin Luo, Zhichao Ruan 1, Ling Liu 2

Objective: Observational studies have shown an association between 25-hydroxyvitamin D (25(OH)D) and epilepsy, but it is unclear whether the association is causal. Therefore, we applied Mendelian randomization (MR) analysis to determine the causal relationship between serum 25(OH)D levels and epilepsy.

Methods: We conducted a two-sample Mendelian randomization (TSMR) study to investigate the association between serum 25(OH)D levels and epilepsy using pooled statistics from genome-wide association studies (GWAS). Data for 25(OH)D came from a GWAS comprising 417,580 participants, and data for epilepsy were obtained from the International League Against Epilepsy (ILAE) consortium. Five methods were used to analyze TSMR, including the inverse variance weighting method, MR Egger method, weighted median method, simple model, and weighted model. In the sensitivity analysis, MR Egger and MR PRESSO methods were used to test for pleiotropy, inverse variance weighting and MR Egger in Cochran's Q statistics were used to test for heterogeneity.

Results: MR analyzed the relationship between 25(OH)D and different types of epilepsy, and the results showed that a 1 standard deviation increase in natural log-transformed serum 25(OH)D levels was associated with reduced risk for juvenile absence epilepsy (IVW OR = 0.985; 95% confidence interval (CI): 0.971-0.999; P-value = 0.038). There was no apparent heterogeneity and horizontal gene pleiotropy.

Significance: Higher serum levels of 25(OH)D were a protective factor for adolescent absence epilepsy, but had no effect on other types of epilepsy.
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From the web: "Juvenile absence epilepsy (JAE) is a type of epilepsy that causes absence (“ab-SONCE”) seizures. During a seizure, the child will stare and stop what they are doing. They may blink quickly or move their hands. They may look like they are daydreaming or not paying attention. These seizures last only a few seconds."
JAE accounts for 1 to 2% of childhood epilepsies .

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Antiseizure Medications reduce vitamin D genes, need new guidelines – Feb 2023

Vitamin D Supplementation in Children on Antiseizure Medications: High Time to Have Proper Guidelines
Indian Journal of Pediatrics
Kaushik Ragunathan & Biswaroop Chakrabarty

A recent meta-analysis highlighted significantly reduced serum vitamin D levels in epileptic children receiving valproate monotherapy compared to healthy controls. Although it is not a conventional hepatic enzyme inducer, there are reports of valproate inducing CYP3A4 and CYP24A1, both involved in vitamin D catabolism [1]. Valproate activates pregnane X receptor which regulates the expression of vitamin D responsive genes [2]. Apart from its importance in bone growth and development, vitamin D also plays a significant role in the functioning of muscular, immune, and cardiovascular systems [1].
Studies by Viraraghavan et al. and Mikati et al. have shown the utility of vitamin D supplementation in children on antiseizure medications (ASMs) [3, 4]. The present study by Mishra et al. is a welcome addition in that direction, evaluating the utility of vitamin D supplementation in children on valproate monotherapy [5].
Mishra et al. studied children aged 2–12 y with new onset epilepsy on valproate monotherapy with vitamin D–sufficient status at baseline. They were randomized into 2 arms: intervention arm receiving vitamin D (600 IU/d) for a period of 90 d and a control group receiving only ASM. The median vitamin D level significantly increased and decreased, respectively, in the intervention and control arms over 3 mo [5].
Mikati et al. and Viraraghavan et al. included cases of a variety of ASMs as mono- or polytherapy. Although Viraraghavan included new-onset epilepsy cases, subjects in the study by Mikati et al. were on ASM for at least 6 mo. Viraraghavan et al. prescribed 60,000 IU/mo of vitamin D in the intervention arm, whereas Mikati et al. had two arms, one receiving 400 IU/d and another receiving 2000 IU/d of vitamin D. Contrary to the study by Mishra et al., both of these studies included cases of vitamin D deficiency at baseline [3, 4]. Viraraghavan et al. demonstrated maintained serum vitamin D levels at 6-mo follow-up in the intervention arm compared to a significant decrease in the control arm [3]. Mikati et al. found a significant increase in both intervention groups at 1-y follow-up; however, the values were comparable in both groups. They also documented increases in bone mineral density at multiple skeletal sites in both arms [4]. The study by Mishra et al. reinforces the fact that even children with vitamin D–sufficient status show a significant fall in serum levels on ASM therapy that can be prevented by vitamin D supplementation.
The Endocrine Society recommends at least 2–3 times the RDA of vitamin D on ASM polytherapy [6]. Recent literature has unveiled possible anticonvulsant effects of vitamin D mediated by reduction in voltage-sensitive calcium channel expression, inhibition of iNOS, and suppression of inflammatory cytokines [7]. Mishra et al. did not show any difference in breakthrough seizures between the control and intervention arms; however, the follow-up is only for 90 d [5].
Thus, the current study further reiterates the utility of vitamin D supplementation in children with epilepsy and paves the way for future studies on various ASM mono- and polytherapies, including the long-term effect of vitamin D on seizure control.
 Download the PDF from VitaminDWiki

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Epilepsy 5.4 X more likely if premature birth (assocated with low vitamin D) - Sept 2021

Hypovitaminosis D and risk factors in pediatric epilepsy children
BMC Pediatrics Vol 21, # 432 (2021) https://doi.org/10.1186/s12887-021-02906-7
Napakjira Likasitthananon, Charcrin Nabangchang, Thitiwan Simasathien, Suchavadee Vichutavate, Voraluck Phatarakijnirund & Piradee Suwanpakdee

Background
Anti-seizure medication (ASM) treatment is one of the significant risk factors associated with abnormal vitamin D status in epilepsy patients. Multiple studies have shown that adult epilepsy patients can exhibit vitamin D deficiency. However, there are few reports investigating pediatric epilepsy patients. In this study, we aimed to identify risk factors related to hypovitaminosis D in pediatric epilepsy patients in Thailand.

Methods
A cross-sectional retrospective cohort study was conducted in 138 pediatric epilepsy patients who received anticonvulsants from April 2018 to January 2019. Demographic data, seizure types, puberty status, physical activity, duration, and types of anti-seizure medications were analyzed. Patients with abnormal liver function, abnormal renal function, and who received vitamin D supplements or ketogenic diet containing vitamin D were excluded. Levels of serum vitamin D (25(OH)D) were measured.

Results
All 138 subjects were enrolled, the age ranged from 1.04 – 19.96 years; (mean = 9.65 ± 5.09), the mean serum 25(OH) D level was 26.56 ± 9.67 ng/ml. The prevalence of vitamin D deficiency was 23.2% and insufficiency was 47.8% respectively. Two risk factors—puberty status (OR 5.43, 95% CI 1.879-15.67) and non-enzyme-inhibiting ASMs therapy (OR 3.58, 95% CI 1.117-11.46)—were significantly associated with hypovitaminosis D, as shown by multivariate analyses.

Conclusions
Our study reports the high prevalence of hypovitaminosis D in pediatric epilepsy patients in Thailand despite being located in the tropical zone. These findings can guide clinicians to measure vitamin D status in pediatric epilepsy patients particularly when they reach puberty and/or are using non-enzyme-inhibiting ASMs therapy. Early detection of vitamin D status and prompt vitamin D supplementation can prevent fractures and osteoporosis later in life.
 Download the PDF from VitaminDWiki

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101+ VitaminDWiki pages with PRE-TERM etc in title

This list is automatically updated

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Seizures associated with low vitamin D - June 2021

Micronutrient characteristic in recurrent seizure in medicinecontrolled epileptic children with normal nutritional status!!!Siezures associated with low vitamin D - June 2021
Acta Neurol Taiwan . 2021 Jun;30(2):54-62.
Irwanto Idris 1, Chasan Ismail 1, Muhammad Riski Darmawan Moestakim 1
 Download the PDF from VitaminDWiki

Background: Recurrent seizure in epileptic children is correlated with future motoric disorders, behavior problems, and intellectual disabilities. Various factors are thought to modulate the risk of recurrent seizure, including micronutrient status such as calcium, 25-dehydroxycholecalciferol (25-(OH)D), and serum iron presented as hemoglobin level.

Aim: To analyze correlation between micronutrient characteristics of epileptic children and recurrence of seizure.

Methods: This cross-sectional retrospective study was conducted in the pediatric clinic of Dr. Soetomo hospital from September to October 2019. Epileptic children with long-term anti-epileptic drugs (AED) for over 6 months and ages ranging 2-18 years were included. Recurrent and non-recurrent group were compared. Age, family history of seizure, and duration of AED administration were noted. Peripheral serum level of hemoglobin, calcium, and 25-(OH)D was measured. The median 25-(OH) D level of both groups were corelated with recurrent seizure by using Spearman test (95% confidence interval).

Results: Thirty children were enrolled. Recurrent seizure was occurred in 19 children. There was significant correlation on hemoglobin and calcium, and 25-(OH)D level with the recurrence of seizure (p less then 0.05). Among all observed micronutrients, 25-(OH)D has the strongest correlation (r = 0.750). There was no significant correlation between recurrent seizure and both family history and AED administration duration.

Conclusion: Micronutrients status is correlated with prevalence of recurrent seizure. Level of 25-(OH)D is strongly correlated, whereas level of hemoglobin, and calcium have weak correlation with recurrent seizure in epileptic children.

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Digestive problems with Epilepsy (perhaps need Gut-Friendly Vitamin D ) - Aug 2021

Functional Gastrointestinal Disorders in Patients With Epilepsy: Reciprocal Influence and Impact on Seizure Occurrence
Front. Neurol., 06 August 2021 Volume 12 - 2021 | https://doi.org/10.3389/fneur.2021.705126
Federica Avorio1,2†, Emanuele Cerulli Irelli1†, Alessandra Morano1, Martina Fanella1, Biagio Orlando1, Mariarita Albini3, Luca M. Basili1, Gabriele Ruffolo4, Jinane Fattouch1, Mario Manfredi1, Emilio Russo5, Pasquale Striano6, Marilia Carabotti7, Anna T. Giallonardo1, Carola Severi8 and Carlo Di Bonaventura1*

Introduction: The complex relationship between the microbiota-gut-brain axis (MGBA) and epilepsy has been increasingly investigated in preclinical studies. Conversely, evidence from clinical studies is still scarce. In recent years, the pivotal role of MGBA dysregulation in the pathophysiology of functional gastrointestinal disorders (FGID) has been recognized. With this background, we aimed to investigate the prevalence of FGID in patients with epilepsy (PWE) and the possible impact of bowel movement abnormalities on seizure recurrence.

Methods: A total of 120 PWE and 113 age-, sex-, and BMI-matched healthy subjects (HS) were consecutively enrolled. A questionnaire to evaluate the presence of FGID (according to Rome III diagnostic criteria) was administered to all participants. In a subgroup of drug-resistant patients, we administered an ad-hoc questionnaire combining Bristol stool charts and seizure diaries to evaluate seizure trends and bowel movement changes.

Results: A higher prevalence of FGID in PWE (62.5%) than in HS (39.8%) was found (p < 0.001). The most frequently observed disorder was constipation, which was significantly higher in PWE than in HS (43.3 vs. 21.2%, p < 0.001), and was not associated with anti-seizure medication intake according to multivariable analysis. In drug-resistant patients, most seizures occurred during periods of altered bowel movements, especially constipation. A significant weak negative correlation between the number of days with seizures and the number of days with normal bowel movements was observed (p = 0.04). According to multivariable logistic regression analysis, FGID was significantly associated with temporal lobe epilepsy as compared with other lobar localization (p = 0.03).

Conclusions: Our clinical findings shed new light on the complex relationship between epilepsy and the MGBA, suggesting a bidirectional link between bowel movement abnormalities and seizure occurrence. However, larger studies are required to better address this important topic.
 Download the PDF from sci-hub via VitaminDWiki

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Review of Epilepsy trials with supplements- Nov 2020

. 2020 Oct 29;S0261-5614(20)30591-4. doi: 10.1016/j.clnu.2020.10.045
Clinical trials of vitamin-mineral supplementations in people with epilepsy: A systematic review
Ali A Asadi-Pooya 1, Leila Simani 2

Objective: The purpose of the current study was to systematically review the literature on the clinical trials of vitamin-mineral supplementations in people with epilepsy (PWE) to treat their seizures.

Methods: MEDLINE and Scopus from inception to August 25, 2020 were searched for related published manuscripts. The search keywords included "vitamin or folate or folic acid or biotin or thiamine or carnitine or zinc or manganese or selenium or omega-3 fatty acid or linoleic acid or micronutrient or trace element or supplementation" AND "epilepsy or seizure".

Results: We could identify 26 related articles. Seventeen studies provided class 2 of evidence and the rest provided class 3 of evidence. Eight studies investigated polyunsaturated fats, seven groups studied folic acid, four studies explored the effects of vitamin D, two investigated vitamin E, and three others studied multivitamin cocktails. There was one study on zinc and one on selenium. There is some evidence on the efficacy of polyunsaturated fats in treating seizures in PWE. The evidence on the efficacy of multivitamin cocktails in adults is promising.

Conclusion: High quality data on the efficacy of nutritional (vitamins-minerals) supplementations in treating seizures in PWE is scarce; however, designing future clinical trials of polyunsaturated fatty acid supplementation for drug-resistant seizures in adults with focal epilepsy and in children, and also multivitamin supplementations in adults with focal epilepsy seems reasonable and promising. Such clinical trials should be well-designed, randomized, and placebo controlled, with enough sample size and adequate follow-up of 12 months or more.
 Download the PDF from sci-hub via VitaminDWiki

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6,600 IU vitamin D doubled levels for those with antiepileptic drugs - April 2021

Vitamin D deficiency in a Portuguese epilepsy cohort: who is at risk and how to treat
Epileptic Disord . 2021 Apr 19. doi: 10.1684/epd.2021.1268

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Epilepy and Vitamin D Meta-analyses

Epileptics have slightly lower levels of Vitamin D – meta-analysis Aug 2024

Vitamin D content and prevalence of vitamin D deficiency in patients with epilepsy：a systematic review and meta-analysis Provisionally accepted
Front. Nutr. Sec. Nutritional Epidemiology Volume 11 - 2024 doi: 10.3389/fnut.2024.1439279 FREE PDF sometime in the future
Liu Yuanyuan Liu Yuanyuan 1Chao Gong Chao Gong 1Jiawei Li Jiawei Li 1Xin Ning Xin Ning 1Pei Zeng Pei Zeng 1Luchuan Wang Luchuan Wang 2Beibei Lian Beibei Lian 1Jiahao Liu Jiahao Liu 1Liya Fang Liya Fang 1Jin Guo Jin Guo 3*
1 School of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
2 First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang Province, China
3 Jiamusi University Affiliated No.3 Hospital, Jiamusi, Heilongjiang Province, China

The prevalence of vitamin D deficiency and vitamin D levels in patients with epilepsy (PWE) were systematically evaluated, and the differences between subgroups were analyzed. We identified all articles investigating the prevalence of vitamin D deficiency in patients with epilepsy from the database established in March 2024 from PubMed, Web of Science, and Embase.
We divided them into anti-seizure medication (ASM) interventions and non-ASM interventions according to whether or not someone used ASM. A total of 68 articles were included. The prevalence of newly diagnosed epilepsy was 50.2%(95 % CI: 38.7% -61.7% ), and the prevalence after ASM intervention was 47.9%(95 % CI: 40% -55.9% ), including 7070 patients with epilepsy. Subgroup and meta-regression analyses were performed according to the diagnostic criteria, economic development level, region, age, ASM treatment, and other factors. The results showed that the differences were not significant.
In addition, the vitamin D content of epilepsy patients (18.719 ng/mL ) was lower than that of healthy people (20.295 ng/mL ).
The prevalence of vitamin D deficiency in patients with epilepsy is very high. Still, the related factors have little effect on the high prevalence of vitamin D in epilepsy, and ASM intervention can reduce the vitamin D content in patients with epilepsy. Therefore, it is emphasized that monitoring vitamin D levels is part of the routine management of patients with epilepsy.

Individuals using antiepileptic drugs need vitamin D - meta-analysis March 2020

Vitamin D Deficiency in Pediatric Patients Using Antiepileptic Drugs: Systematic Review With Meta-Analysis
Review J Pediatr (Rio J), 2020 Mar 11, DOI: 10.1016/j.jped.2020.01.004
Cíntia Junges 1, Tania Diniz Machado 2, Paulo Ricardo Santos Nunes Filho 3, Rudimar Riesgo 2, Elza Daniel de Mello 2
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Objectives: To measure the prevalence of vitamin D deficiency (through the 25-hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs.

Source of data: Meta-analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019.

Summary of data: A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI=0.25-0.41; I2=92%, p<0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450-inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI=0.21-0.47; I2=86%, p<0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI=0.40-0.64; I2=76%, p<0.01).

Conclusions: Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25-hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present.

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Anti-epileptic drugs reduce Vit D, 60,000 IU monthly increases level, even with drugs – RCT Nov 2018

Effect of high dose vitamin d supplementation on vitamin d nutrition status of pre-pubertal children on anti-epileptic drugs – A randomized controlled trial
Clinical Nutrition ESPEN, https://doi.org/10.1016/j.clnesp.2018.11.007

Background and aims
Patients on long term anti-epileptic drug therapy are prone for Vitamin D deficiency for a myriad of reasons. The aim of this research was to study the effect of high dose vitamin D supplementation on vitamin D nutrition status of children newly started on anti-epileptic drug therapy.

Materials
This randomized controlled trial was conducted in a tertiary care Children's Hospital at New Delhi from November 2011 to March 2013. Eighty three children in the age group 5–10 years newly started on anti-epileptic drugs (AED) were randomized into two groups; group A – the intervention group, to whom 60,000 IU vitamin D3 was given orally/month under direct supervision along with AED for a period of 6 months, and group B- the control group, to whom AED without vitamin D3 was given. Serum 25(OH)D, ionized calcium (iCa), total calcium (tCa), inorganic phosphate (iP), alkaline phosphatase (ALP) and parathyroid hormone (PTH) levels were assayed at baseline and at the end of 6 months and were compared within and between the two groups.

Results
The mean 25(OH)D in Group A was maintained at 6 months follow up [ 26 ng/ml, 95% CI 20–34 ng/ml] compared to baseline [25 ng/ml, 95% CI −19 to 33 ng/ml] [ p = 0.83]. In group B, there was a significant decrease in 25(OH)D levels at 6 months [13 ng/ml (95% CI 9 ng/ml–17 ng/ml)] compared to baseline [18 ng/ml (95% CI 13–24 ng/ml)] [p = 0.01]. At 6 months, mean serum 25(OH)D was significantly higher in group A as compared to group B (p = 0.005).

Conclusion: To conclude, oral administration of 60,000 IU vitamin D3/month is sufficient to maintain serum 25(OH)D level and prevent development of vitamin D deficiency in children newly started on AED over a period of 6 months. Non supplementation leads to the lowering of serum 25(OH)D in these children.

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Antiepileptic drugs associated with alarmingly low Vitamin D – Aug 2018

The impact of Antiepileptic drugs on Vitamins levels in epileptic patients.
Curr Pharm Biotechnol. 2018 Aug 15. doi: 10.2174/1389201019666180816104716
Shaikh AS1, Guo X1, Li Y2, Cao L2, Liu X2, Li P1, Zhang R1, Guo R1.
1 Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan. China.
2 Department of Neurology, Qilu Hospital of Shandong University, Jinan. China.

BACKGROUND:
The impact of antiepileptics on serum vitamin levels is controversial and uncertain. With no clear conclusions on the impact of antiepileptics on serum levels of vitamins, there is a need for further clinical studies in order to ascertain the impact of old and newer antiepileptic drugs on serum levels of vitamins in epileptic patients, thus accomplishing a suitable usage of vitamins supplementation.

OBJECTIVE:
The intention of the present research is to confirm the hypothesis of whether or not vitamin levels are altered with antiepileptic drugs. The study also aims to reveal which vitamin levels are particularly more altered, are vitamin levels affected by gender and the type and number of antiepileptics used.

METHODS:
The present research was piloted in collaboration with the Department of Neurology in Qilu Hospital of Shandong University. A total of 63 serum samples of epileptic patients receiving antiepileptics as monotherapy or polytherapy were requested for analysis of nine vitamin serum levels. Total nine vitamins (B1, B2, B6, B9, B12, A, C, D and E) in epileptic patients receiving antiepileptic drugs were analyzed. The serum results of all vitamins were compiled and evaluated with SPSS.

RESULTS:
It was alarmingly found that serum levels of vitamin D were particularly very low in almost all (90%) epileptic patients in this study. Notably, serum levels of vitamin C and vitamin B1 were also below reference range in 72% and 46% epileptic patients, respectively. The remaining vitamins were almost in reference range for most of the patients. In our study, mean and frequency of vitamin D, C and B1 levels do not vary too much among different gender groups. The patients receiving newer antiepileptic drugs displayed a slightly increased serum vitamin D levels in comparison to the patients receiving older antiepileptic drugs. We found low vitamin D, C and B1 serum levels in patients who were on monotherapy as in comparison with patients on polytherapy.

CONCLUSION:
The most significant and surprising finding of this study revealed that serum vitamin D levels in particular were very low in almost all patients and in some patients vitamin B1 serum levels were also below the reference range. More importantly, it is first time reported here that vitamin C serum levels were also below reference range in the majority of these Chinese epileptic patients. It is recommended that all these vitamins should be regularly monitored in addition to therapeutic drug monitoring of antiepileptic drugs. Additional clinical trials are required for further evaluation. It is also recommended that epileptic patients with low serum levels of these vitamins may be prescribed vitamins supplementations with antiepileptic drugs in order to control their seizures more effectively and efficiently.

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Many Antiepileptic drugs decrease Vitamin D - Feb 2017

• Epilepsy and vitamin D: a comprehensive review of current knowledge Feb 2017
  • Seems like a comprehensive study, PDF from sci-hub
  
  

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Antiepileptic drugs reduce vitamin D levels - 2016

Effect of Antiepileptic Therapy on Serum 25(OH)D3 and 24,25(OH)2D3 Levels in Epileptic Children
Ann Nutr Metab. 2016;68(2):119-27. doi: 10.1159/000443535. Epub 2016 Jan 27.
He X1, Jiang P, Zhu W, Xue Y, Li H, Dang R, Cai H, Tang M, Zhang L, Wu Y.
Institute of Clinical Pharmacy and Pharmacology, Second Xiangya Hospital, Changsha, China.

BACKGROUND:
Vitamin D deficiency is not only associated with the adverse effects of chronic treatment with antiepileptic drugs (AEDs), but also with epilepsy. Although emerging evidence suggests that AEDs can accelerate the vitamin D catabolism, resulting in suboptimal vitamin D status, there are a limited number of studies examining the vitamin D status in epileptic patients, especially in first-episode or AEDs-naïve children.
METHODS:
Determined with high-performance liquid chromatography-tandem mass spectrometry, circulating 25(OH)D3 and 24,25(OH)2D3 levels, and 24,25(OH)2D3:25(OH)D3 ratio were compared between AEDs-treated epileptic (n = 363) and control (n = 159) children. To further figure out whether the patients were in a vitamin D deficient prone state even before treatment, epileptic children before their initiation of treatment (n = 51) were enrolled into a follow-up study.
RESULTS:
A significant decrease of 25(OH)D3 and 24,25(OH)2D3 levels, but a significant increase of 24,25(OH)2D3:25(OH)D3 ratio was observed in epileptic children, compared with controls. Baseline 25(OH)D3, 24,25(OH)2D3 and 24,25(OH)2D3:25(OH)D3 ratio in the follow-up group were similar to those in controls, but significantly changed with 2 months of AED therapy.
CONCLUSIONS:
Disturbed vitamin D levels were possibly the consequence of AED therapy, rather than the contributing factor of epilepsy. Collectively, circulating vitamin D levels should be monitored and corrected in AEDs-treated epileptic children.

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Epilepsy appears to be treated by Vitamin D (starting 5,000 IU RCT) – Dec 2016

Vitamin D for the Treatment of Epilepsy: Basic Mechanisms, Animal Models and Clinical Trials
Front. Neurol. | doi: 10.3389/fneur.2016.00218
Kevin Pendo 2 and Christopher M. DeGiorgio, MD 1*
1 University of California, USA, 2 Princeton, USA

There is increasing evidence supporting dietary and alternative therapies for epilepsy, including the ketogenic diet, modified Atkins diet, and omega-3 fatty acids. Vitamin D is actively under investigation as a potential intervention for epilepsy. Vitamin D is fat soluble steroid which shows promise in animal models of epilepsy. Basic research has shed light on the possible mechanisms by which Vitamin D may reduce seizures, and animal data support the efficacy of Vitamin D in rat and mouse models of epilepsy. Very little clinical data exists to support the treatment of human epilepsy with Vitamin D, but positive findings from preliminary clinical trials warrant larger Phase I and II clinical trials in order to more rigorously determine the potential therapeutic value of Vitamin D as a treatment for human epilepsy.

From the end of the conclusion section
"Recently, our group has received an IND for a Phase I study of Vitamin D3 in drug-resistant epilepsy to study the safety, preliminary efficacy and potential cardiac benefits of Vitamin D3 5000 IU/day in drug-resistant epilepsy."
 Download the PDF from VitaminDWiki
[https://scholar.google.com/scholar?cites=10460289673450969790&as_sdt=5,48&sciodt=0,48&hl=en|30 citations of study as of Jan 2023

• Safety and tolerability of Vitamin D3 5,000 IU/day in epilepsy - May 2019 https://doi.org/10.1016/j.yebeh.2019.03.001 by DeGiorgio  PDF from Sci-Hub via VitaminDWiki
  • "The median percent change in seizure frequency was − 26.9% at six weeks,"

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Epilepsy associated with low vitamin D, even before drug therapy started - Oct 2015

Vitamin D Deficiency in Children With Newly Diagnosed Idiopathic Epilepsy
J Child Neurol October 2015 vol. 30 no. 11 1428-1432
Fatma Mujgan Sonmez, MD1⇑, Ahsen Donmez, MD2, Mehmet Namuslu, MD3
Metin Canbal, MD4, Emel Orun, MD2
1Department of Child Neurology, Turgut Ozal University, Ankara, Turkey
2Department of Pediatrics, Turgut Ozal University, Ankara, Turkey
3Department of Biochemistry, Turgut Ozal University, Ankara, Turkey
4Department of Family Medicine, Turgut Ozal University, Ankara, Turkey
Fatma Mujgan Sonmez, MD, Department of Child Neurology, Turgut Ozal University, Alparslan Turkes Caddesi, No: 57 Emek, Ankara 06560, Turkey. Email: mjgsonmez at yahoo.com

Several studies have shown a link between vitamin D deficiency and epilepsy. This study includes 60 newly diagnosed idiopathic epilepsy patients and 101 healthy controls (between the ages of 5 and 16). Each group was also divided into two subgroups according to seasonal changes in terms of months of longer versus shorter daylight. We retrospectively evaluated the levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25-OH vitamin-D3 in the study participants. Levels below 20 ng/ml were defined as vitamin D deficiency and levels of 20-30 ng/ml as insufficiency. There were no significant differences in age, gender distribution and levels of calcium, phosphorus, alkaline phosphatase and parathyroid hormone between the groups. The level of 25-OH vitamin-D3 in the patient group was significantly lower when compared to the control group (p < 0.05) (14.07 ± 8.12 and 23.38 ± 12.80 ng/ml, respectively). This difference also held true when evaluation was made according to seasonal evaluation (12.38 ± 6.53 and 17.64 ± 1.14 in shorter daylight and 18.71 ± 9.87 and 30.82 ± 1.04 in longer daylight).

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Idiopathic Epilepsy at AboutKidsHealth

There are a variety of idiopathic epilepsy syndromes. Children with idiopathic epilepsy may have generalized or partial seizures.
Many, although not all, idiopathic epilepsy syndromes are benign and the child will eventually grow out of them.
Relatives of a child with idiopathic epilepsy often have a history of seizures.
What are other terms for idiopathic epilepsy?
An older term for idiopathic epilepsy is primary epilepsy. The terms “idiopathic epilepsy” and “cryptogenic epilepsy” are sometimes used interchangeably, especially in older books and articles.
What causes idiopathic epilepsy?
By definition, there is no apparent underlying cause of idiopathic epilepsy, such as a structural problem with the brain or a metabolic disorder. It is possible that idiopathic epilepsy is caused by tiny abnormalities at the cellular level. We are now learning that many, although not all, idiopathic epilepsy syndromes have an associated genetic component.
In most cases, the exact way in which epilepsy is inherited is unclear. However, some researchers estimate that genes could account for 70% to 90% of the tendency to develop epilepsy.
What epilepsy syndromes are idiopathic?

• benign epilepsy of childhood with centrotemporal spikes (BECTS)
• childhood epilepsy with occipital paroxysms
• benign neonatal familial convulsions
• benign neonatal convulsions
• benign myoclonic epilepsy in infancy
• childhood absence of epilepsy
• juvenile absence epilepsy
• juvenile myoclonic epilepsy

How many other children have idiopathic epilepsy?
Idiopathic epilepsy is common; about 30% of childhood epilepsy is idiopathic.
Together, idiopathic and cryptogenic epilepsy account for 55% to 75% of cases of childhood epilepsy.
It is difficult to be precise, because different researchers define these terms differently.
How is idiopathic epilepsy treated?
Idiopathic epilepsy is treated with anti-epileptic drugs.
What is the outlook for a child with idiopathic epilepsy?
The outlook for a child with idiopathic epilepsy depends on the specific condition and how well the seizures respond to treatment.
Several idiopathic epilepsy syndromes, such as childhood absence epilepsy and BECTS, usually go away on their own.
With other syndromes, though, the child may need to take anti-epileptic drugs all his life.
Elizabeth J. Donner, MD, FRCPC, 2/4/2010

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About one percent of Americans have some form of epilepsy, and nearly four percent (1 in 26) will develop epilepsy at some point in their lives. The number of Americans who have epilepsy is greater than the number who have multiple sclerosis, Parkinson's disease, and cerebral palsy combined.

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 see also "Epidemiology of Idiopathic Generalized Epilepsies" - 2005 VitaminDWiki

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Anti-epilepsy drugs are known to decrease Vitamin D levels, yet they still only recommend 400 IU - 2020

Should vitamin D supplementation routinely be prescribed to children receiving antiepileptic medication?
 Download the PDF from sci-hub via VitaminDWiki

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See also PubMed

• Safety and tolerability of Vitamin D3 5000 IU/day in epilepsy April 2019
  • "Median seizure frequency declined from 5.18 seizures per month to 3.64 seizures per month at 6 weeks and to 4.2 seizures per month at 12 weeks" doi: 10.1016/j.yebeh.2019.03.001
  • Download the PDF from Sci-Hub via VitaminDWiki
• "Vitamin D3 for the Treatment of Epilepsy: Basic Mechanisms, Animal Models, and Clinical Trials" Dec 2016
  •  Download the PDF from VitaminDWiki
• Bone Health and Vitamin D Status in Young Epilepsy Patients on Valproate Monotherapy April 2016
  "Prevalence of low BMD (Z-score ≤−2.0) was 26% and 10% at lumbar spine, and 10% and 4% at femoral neck in epileptic and control groups respectively. No correlation was found between duration or dosage of VPA and BMDs. Vitamin D deficiency (≤20 ng/ml) was highly prevalent (>90%) in epilepsy patients and controls."
• The roles of vitamin B12 and vitamin D in children with intractable epilepsy Jan 2015
  "a clear association between vitamin D and vitamin B12 treatment and epilepsy was identified" full free text online
• Low vitamin D levels are common in patients with epilepsy Oct 2014
  Due to antiepileptic drugs. full free text online
• Correction of vitamin D deficiency improves seizure control in epilepsy: A pilot study May 2012
  "Median seizure reduction was 40%"
  Loading dose then a maintenance dose of 2000 to 2600 IU daily

• Epilepsy and vitamin D: a comprehensive review of current knowledge Dec 2016, Behind a $42 paywall
  Seyed Amir Miratashi Yazdi, Mehdi Abbasi, Seyed Masoud Miratashi Yazdi; DOI: https://doi.org/10.1515/revneuro-2016-0044.
  "In this article, we review the possible relationship between vitamin D and epilepsy from different aspects, including the action mechanism of vitamin D in the central nervous system and ecological and epidemiological findings. We also present the outcome of studies that evaluated the level of vitamin D and the impact of administrating vitamin D in epileptic patients or animal subjects"

See also web

• http://www.epilepsy.org.au/resources/for-media/facts-statistics-about-epilepsy has such factoids as:
  According to the World Health Organisation, epilepsy is the world's most common serious brain disorder
  Epilepsy is more than three times as common as multiple sclerosis, Parkinson’s disease and cerebral palsy
  It is commonly thought that epilepsy always involves convulsions.
    In fact there are around 40 different types of epilepsy and epilepsy syndromes.
• http://www.epilepsy.com/learn/diverse-communities/epilepsy-and-african-american-community
  "More people live with epilepsy than with autism spectrum disorders, Parkinson’s disease, multiple sclerosis and cerebral palsy combined"
• Children with epilepsy advised to take vitamin D July 2013
  But only enough vitamin D to deal with bone loss problems, not treat Epilepsy
• Association of Unintended Pregnancy With Spontaneous Fetal Loss in Women With Epilepsy JAMA Jan 2019
  2X more likely to have fetal loss, no mention of low vitamin D due to Epilepsy drugs, 10.1001/jamaneurol.2018.3089
• Potential risk factors for vitamin D levels in medium- and long-term use of antiepileptic drugs in childhood June 2017
  Vitamin D levels dropped 5 ng in 5 years (average time)
• Vitamin D supplementation for bone health in adults with epilepsy: A systematic review April 2018
  1800 IU was not enough to help bones (review of 9 studies)
• Epilepsy and vitamin D: a comprehensive review of current knowledge Feb 2017
  Seems like a comprehensive study, PDF is available free at Sci-Hub  0.1515/revneuro-2016-0044
  

1 in 26 will be diagnosed as Epileptic during their life

Epilepsy Incidence Doubled in a Decade

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CBD helps some people with Epilepsy

• Marijuana Use in Epilepsy: The Myth and the Reality Aug 2015
  Behind a paywall, but patients can get a copy of PDF for free
  CBD is legal (vs THC) and is sold on Amazon.
  One brand of CBD was named after the girl whose seizures reduced from 300/month to 1/month
• Cannabis helps my epileptic son. If only we had known sooner April 2016
  Mother had refined Cannabis to make CBD,
  Incorrectly believes that govt does not permit it,
• Can Cannabis Treat Epileptic Seizures? Scientific American Jan 2016
  "Stories of cannabis’s abilities to alleviate seizures have been around for about 150 years . . "
  "The researchers reported the intervention reduced motor seizures at a rate similar to existing drugs (a median of 36.5 percent) and 2 percent of patients became completely seizure free. Additionally, 79 percent of patients reported adverse effects such as sleepiness, diarrhea and fatigue, although only 3 percent dropped out of the study due to adverse events. "
• Update Dec 2016 US Drug Enforcement Agency has classifiedCBD as bad as Cocaine, heroin etc
  Note: I am unaware of any cases of CBD addiction
  Link has 219 pages of studies showing the benefits of CBD

Suspect that there are several types of Epilepsy, and that not all benefit from CBD

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