What vitamin deficiencies are associated with seizures?

From the Guidelines

Vitamin B6 (pyridoxine) deficiency is the most significant vitamin deficiency associated with seizures, particularly in infants and young children, and requires immediate supplementation with 50-100mg of intravenous pyridoxine during acute seizures, followed by daily oral maintenance doses of 15-30mg. This is based on the evidence from the ESPGHAN guidelines on pediatric parenteral nutrition, which highlights the crucial role of pyridoxine in neurotransmitter synthesis and amino acid metabolism 1. Other vitamin deficiencies, such as vitamin B12 (cobalamin), vitamin D, vitamin E, and biotin, can also contribute to seizures, but the evidence is less clear-cut. For example, vitamin B12 deficiency can lead to neurological symptoms, including seizures, and is typically treated with intramuscular injections of 1000mcg daily for one week, then weekly for a month, followed by monthly maintenance 1. Vitamin D deficiency may lower seizure threshold, and supplementation with 1000-4000 IU daily is recommended to maintain optimal levels 2. Vitamin E deficiency can cause neurological symptoms, including seizures, and is treated with 400-800 IU daily 2. Biotin deficiency, though rare, can cause seizures and requires 5-10mg daily supplementation 1.

Key Points to Consider

• Pyridoxine deficiency is a significant cause of seizures in infants and young children
• Other vitamin deficiencies, such as vitamin B12, vitamin D, vitamin E, and biotin, can also contribute to seizures
• Prompt identification and correction of these deficiencies can significantly improve seizure control in affected individuals
• The ESPGHAN guidelines provide recommendations for pyridoxine supplementation in infants and children, including a daily dose of 0.15-0.2 mg/kg/day for preterm and term infants up to 12 months of age, and 1.0 mg/day for older children 1

Treatment and Prevention

• Immediate supplementation with 50-100mg of intravenous pyridoxine during acute seizures, followed by daily oral maintenance doses of 15-30mg, is recommended for pyridoxine deficiency
• Vitamin B12 deficiency is typically treated with intramuscular injections of 1000mcg daily for one week, then weekly for a month, followed by monthly maintenance
• Vitamin D deficiency is treated with supplementation of 1000-4000 IU daily to maintain optimal levels
• Vitamin E deficiency is treated with 400-800 IU daily
• Biotin deficiency is treated with 5-10mg daily supplementation

From the Research

Vitamin Deficiencies Associated with Seizures

• Vitamin B12 deficiency has been linked to seizures in infants, with symptoms including megaloblastic anemia, feeding difficulties, and developmental delay 3
• Vitamin B6 deficiency has been reported to cause seizures in adults with chronic alcoholism 4
• Folic acid supplementation has been investigated as a potential treatment for seizures, but studies have found no significant effects on seizure frequency or other outcomes 5
• Vitamin D supplementation has been shown to improve bone mineral content in patients with epilepsy taking antiepileptic drugs 5
• Vitamin E supplementation has been found to decrease seizure frequency in one small study 5
• Thiamine supplementation has been found to improve neuropsychological functions related to psychomotor speed, visuospatial abilities, and selective attention in one small study 5

Evidence for Vitamin Supplementation in Epilepsy

• A systematic review of clinical trials found some evidence for the efficacy of polyunsaturated fats and multivitamin cocktails in treating seizures in people with epilepsy 6
• Another review found that vitamins have antioxidant, anti-inflammatory, and immunomodulatory effects, which can be beneficial for the treatment of epilepsy 7
• However, the evidence for vitamin supplementation in epilepsy is generally limited, and high-quality studies are needed to fully understand its potential benefits and risks 5, 7, 6

Specific Vitamins and Seizures

• Vitamin B12: seizures have been reported in infants with Vitamin B12 deficiency, and may occur after initiation of Vitamin B12 treatment 3
• Vitamin B6: deficiency may cause seizures in adult patients with chronic alcoholism 4
• Folic acid: no significant effects on seizure frequency or other outcomes have been found in studies 5
• Vitamin D: supplementation has been shown to improve bone mineral content in patients with epilepsy taking antiepileptic drugs 5
• Vitamin E: supplementation has been found to decrease seizure frequency in one small study 5
• Thiamine: supplementation has been found to improve neuropsychological functions related to psychomotor speed, visuospatial abilities, and selective attention in one small study 5