Can anemia cause seizures?

Can Anemia Cause Seizures?

Yes, anemia can cause seizures through several mechanisms, particularly severe iron deficiency anemia and vitamin B12 deficiency, which can directly impact neurological function and seizure threshold.

Mechanisms Linking Anemia to Seizures

Iron Deficiency Anemia

• Multiple studies demonstrate a significant association between iron deficiency anemia and seizures, particularly febrile seizures in children 1, 2, 3
• Iron deficiency prior to the development of anemia may increase the risk of febrile seizures with an odds ratio of 6.18 for patients with ferritin <30 ng/mL 3
• The neurological impact occurs because iron is essential for:
  • Neurotransmitter metabolism
  • Myelination
  • Neuronal energy metabolism

Metabolic Derangements Associated with Anemia

• Hypocalcemia secondary to vitamin D deficiency or hypoparathyroidism can trigger seizures 4
• Hypocalcemic seizures are particularly common in conditions like 22q11.2 deletion syndrome, where 80% of patients have a lifetime history of hypocalcemia 4
• Vitamin B12 deficiency can cause severe encephalopathy with seizures, as documented in infants with maternal pernicious anemia 5

Clinical Presentation and Risk Assessment

High-Risk Presentations

• Severe anemia (Hb <7 g/dL)
• Rapid drops in hemoglobin levels
• Anemia with concurrent metabolic abnormalities:
  • Hypocalcemia
  • Hypomagnesemia
  • Vitamin B12 deficiency

Specific Seizure Types Associated with Anemia

• Febrile seizures in children (particularly with iron deficiency) 2, 3
• Generalized tonic-clonic seizures
• Focal seizures that may be misinterpreted as confusion or memory loss 4

Diagnostic Approach for Seizures in Anemic Patients

1. Complete blood count with differential
2. Iron studies:
   • Serum iron
   • Ferritin (<30 ng/mL increases seizure risk) 3
   • Transferrin saturation
   • Total iron binding capacity
3. Vitamin B12 and folate levels
4. Electrolyte panel:
   • Calcium (ionized and total)
   • Magnesium
   • Phosphate
   • Sodium and potassium
5. Neuroimaging and EEG for patients with seizures to rule out structural causes

Management Strategy

Acute Management

1. Stabilize the patient - Ensure airway, breathing, circulation
2. Treat seizures according to standard protocols
3. Correct electrolyte abnormalities - Particularly calcium and magnesium deficiencies 4
4. Blood transfusion for severe anemia (Hb <10 g/dL) in the acute setting 4

Specific Treatments Based on Anemia Type

• Iron deficiency anemia:
  • Oral iron supplementation
  • Investigate and treat underlying cause
• Vitamin B12 deficiency:
  • Parenteral B12 supplementation can arrest seizures within 24 hours 5
• Hypocalcemia-related seizures:
  • Calcium and vitamin D supplementation
  • Monitor ionized calcium levels 4

Prevention and Follow-up

• Regular monitoring of complete blood count and iron studies in patients with history of seizures
• Prophylactic iron supplementation in high-risk populations
• Calcium and vitamin D supplementation for patients with hypoparathyroidism or other risk factors for hypocalcemia 4
• Folic acid supplementation for patients on antiepileptic medications to prevent medication-induced anemia 6

Important Caveats

• Not all anemic patients will develop seizures; severity and acuity of anemia are important factors
• Seizures may be the presenting symptom of severe anemia before other classic symptoms appear
• Antiepileptic drugs themselves can cause or worsen anemia through various mechanisms including folate deficiency 6
• Correction of the underlying anemia and associated metabolic abnormalities should be prioritized alongside seizure management

Early identification and treatment of anemia may prevent neurological complications including seizures, particularly in vulnerable populations such as young children and pregnant women.