From the Guidelines
Yes, thiamine deficiency can cause seizures. Thiamine (vitamin B1) is essential for proper brain function and energy metabolism in neurons. When thiamine levels become severely depleted, it can lead to a condition called Wernicke's encephalopathy, which may present with seizures among other neurological symptoms.
Key Points to Consider
- Thiamine deficiency disrupts the brain's ability to utilize glucose properly, leading to energy failure in brain cells and subsequent neuronal damage.
- This metabolic disruption can lower the seizure threshold and trigger abnormal electrical activity in the brain.
- Populations at highest risk include those with chronic alcoholism, malnutrition, prolonged vomiting, eating disorders, bariatric surgery patients, and those with malabsorption conditions.
- Treatment involves immediate thiamine supplementation, typically 100-500 mg intravenously for 3-5 days, followed by oral supplementation of 100 mg daily until risk factors are resolved, as recommended by recent guidelines 1.
- Early recognition and treatment of thiamine deficiency are crucial to prevent permanent brain damage and reduce the risk of developing seizures or other serious neurological complications.
Important Considerations for Treatment
- The administration of thiamine should be prescribed without hesitation from admission for 3-4 days in patients admitted to emergency or intensive care, as per the ESPEN micronutrient guideline 1.
- In patients with any suspicion of reduced food intake during the previous days or high alcohol consumption, thiamine 100-300 mg/day should be administered by either oral or IV route 1.
- Clinicians should be educated about the factors that may predispose to thiamine deficiency and the importance of initiating immediate treatment, as emphasized in the British Obesity and Metabolic Surgery Society guidelines 1.
From the FDA Drug Label
Thiamine hydrochloride injection is effective for the treatment of thiamine deficiency or beriberi whether of the dry (major symptoms related to the nervous system) or wet (major symptoms related to the cardiovascular system) variety Thiamine hydrochloride injection should be used where rapid restoration of thiamine is necessary, as in Wernicke’s encephalopathy, infantile beriberi with acute collapse, cardiovascular disease due to thiamine deficiency, or neuritis of pregnancy if vomiting is severe.
The FDA drug label does not answer the question.
From the Research
Thiamine Deficiency and Seizures
- Thiamine deficiency has been linked to an increased risk of seizures, as it plays a crucial role in brain function and neurotransmitter biosynthesis 2, 3.
- Studies have shown that thiamine-dependent enzymes are important for oxidant stress defenses, and a deficiency in thiamine can reduce the seizure threshold 2.
- A study published in 1991 found that 16 out of 50 patients with thiamine deficiency showed epileptic or epileptiform manifestations, suggesting a possible relationship between thiamine deficiency and epilepsy 3.
- Another study published in 2019 found that chronic treatment with thiamine increased the clonic and tonic seizure threshold in mice, suggesting that thiamine may have anticonvulsant effects 2.
Clinical Presentations of Thiamine Deficiency
- Thiamine deficiency can present with a range of clinical manifestations, including encephalopathy, dry beriberi, and wet beriberi 4, 5.
- Seizures can be a manifestation of thiamine deficiency, particularly in patients with subclinical predisposition for seizures 3.
- Thiamine deficiency can also contribute to the development of intensive care unit complications, such as heart failure, delirium, and critical care neuropathy 6.
Diagnosis and Treatment of Thiamine Deficiency
- Thiamine deficiency can be diagnosed clinically, and treatment with thiamine supplementation should be started as early as possible in patients suspected to have thiamine deficiency 4, 5.
- Treatment with thiamine is safe, inexpensive, and simple, and can be life-saving in severe cases of thiamine deficiency 4, 5.