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Ran L, Xu M, Zhang Z, Zeng X. The association of nutrient intake with epilepsy: A cross-sectional study from NHANES, 2013-2014. Epilepsy Res 2024; 200:107297. [PMID: 38215605 DOI: 10.1016/j.eplepsyres.2024.107297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Dietary nutrient supplements are helpful in the treatment of many diseases, but their effect on epilepsy is still controversial. This study aimed to evaluate the association between dietary intake of multiple nutrients and epilepsy. METHODS A total of 3963 participants from the NHANES database were involved in this study. We compared the dietary intake of 14 nutrients between the normal population and those with epilepsy. Univariable and multivariable logistic regression were conducted to evaluate the association of these nutrients with epilepsy. RESULTS Compared with the normal population, the epilepsy patients showed lower intakes of protein, vitamin B1, vitamin B6, Fe, and Zn. Multivariable logistic regression showed the negative association of vitamin B1 (OR = 0.513, 95% CI: 0.293, 0.897) with epilepsy. When vitamin B1 was divided into 4 groups according to quartiles, the highest quartile showed a lower odds ratio (OR = 0.338, 95% CI: 0.115, 0.997) than that of the lowest quartile. In different population stratifications, the association of vitamin B1 with epilepsy was different. Vitamin B1 was negatively associated with the odds ratio of epilepsy among the elderly (OR = 0.243), low-income population (OR = 0.337), and current smokers (OR = 0.283). CONCLUSION Epilepsy patients had significantly lower intakes of vitamin B1, which was inversely associated with epilepsy risk. More detailed clinical trials are needed to accurately evaluate nutritional supplements for epilepsy.
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Affiliation(s)
- Liling Ran
- Department of Pharmacology, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410078, Hunan, China
| | - Mengchang Xu
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410219, China
| | - Zheng Zhang
- Department of Pharmacology, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410078, Hunan, China.
| | - Xin Zeng
- Department of Pharmacy, Hunan Children Hospital, Changsha, Hunan 410007, China.
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2
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Modica JS, Déry C, Canissario R, Logigian E, Bonno D, Stanton M, Dupré N, McDermott MP, Bouchard M, Lang AE, Lizarraga KJ. A systematic review of the potential consequences of abnormal serum levels of vitamin B6 in people living with Parkinson's disease. J Neurol Sci 2023; 450:120690. [PMID: 37210937 DOI: 10.1016/j.jns.2023.120690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/21/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
The prevalences of polyneuropathy and epilepsy are higher in people living with Parkinson's disease (PwPD) when compared to older adults. Vitamin B6 is widely available and affordable. PwPD are at higher risk of having abnormal serum levels of vitamin B6, which are associated with polyneuropathy and epilepsy that are potentially preventable and treatable. Potential contributors to abnormal B6 levels in PwPD include age, dietary habits, vitamin supplement misuse, gastrointestinal dysfunction and complex interactions with levodopa. The literature on the potential consequences of abnormal B6 levels in PwPD is limited by a small number of observational studies focused on polyneuropathy and epilepsy. Abnormal B6 levels have been reported in 60 of 145 PwPD (41.4% relative frequency). Low B6 levels were reported in 52 PwPD and high B6 levels were reported in 8 PwPD. There were 14 PwPD, polyneuropathy and low B6. There were 4 PwPD, polyneuropathy and high B6. There were 4 PwPD, epilepsy and low B6. Vitamin B6 level was low in 44.6% of PwPD receiving levodopa-carbidopa intestinal gel and in 30.1% of PwPD receiving oral levodopa-carbidopa. In almost all studies reporting low B6 in PwPD receiving oral levodopa-carbidopa, the dose of levodopa was ≥1000 mg/day. Rigorous epidemiological studies will clarify the prevalence, natural history and clinical relevance of abnormal serum levels of vitamin B6 in PwPD. These studies should account for diet, vitamin supplement use, gastrointestinal dysfunction, concurrent levels of vitamin B12, folate, homocysteine and methylmalonic acid, formulations and dosages of levodopa and other medications commonly used in PwPD.
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Affiliation(s)
| | - Catherine Déry
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | | | - Eric Logigian
- Department of Neurology, University of Rochester, NY, USA
| | - Deana Bonno
- Department of Neurology, University of Rochester, NY, USA
| | | | - Nicolas Dupré
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, NY, USA
| | - Manon Bouchard
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University of Toronto, Toronto, Ontario, Canada
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3
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Rubinos C, Bruzzone MJ, Blodgett C, Tsai C, Patel P, Hianik R, Jadav R, Boudesseul J, Liu C, Zhu H, Wilson SE, Olm-Shipman C, Meeker R, Hirsch LJ. Association of Serum Pyridoxal Phosphate Levels with Established Status Epilepticus. Neurocrit Care 2023; 38:41-51. [PMID: 36071331 DOI: 10.1007/s12028-022-01579-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/27/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The objective of this study was to determine the prevalence of pyridoxine deficiency, measured by pyridoxal phosphate (PLP) levels, in patients admitted to the hospital with established (benzodiazepine-resistant) status epilepticus (SE) (eSE) and to compare to three control groups: intensive care unit (ICU) patients without SE (ICU-noSE), non-ICU inpatients without SE (non-ICU), and outpatients with or without a history of epilepsy (outpatient). METHODS This retrospective cohort study was conducted at the University of North Carolina Hospitals and Yale New Haven Hospital. Participants included inpatients and outpatients who had serum PLP levels measured during clinical care between January 2018 and March 2021. The first PLP level obtained was categorized as normal (> 30 nmol/L), marginal (≤ 30 nmol/L), deficient (≤ 20 nmol/L), and severely deficient (≤ 5 nmol/L). RESULTS A total of 293 patients were included (52 eSE, 40 ICU-noSE, 44 non-ICU, and 157 outpatient). The median age was 55 (range 19-99) years. The median PLP level of the eSE group (12 nmol/L) was lower than that of the ICU-noSE (22 nmol/L, p = 0.003), non-ICU (16 nmol/L, p = 0.05), and outpatient groups (36 nmol/L, p < 0.001). Patients with eSE had a significantly higher prevalence of marginal and deficient PLP levels (90 and 80%, respectively) than patients in each of the other three groups (ICU-noSE: 70, 50%; non-ICU: 63, 54%; outpatient: 38, 21%). This significantly higher prevalence persisted after correcting for critical illness severity and timing of PLP level collection. CONCLUSIONS Our study confirms previous findings indicating a high prevalence of pyridoxine deficiency (as measured by serum PLP levels) in patients with eSE, including when using a more restricted definition of pyridoxine deficiency. Prevalence is higher in patients with eSE than in patients in all three control groups (ICU-noSE, non-ICU, and outpatient). Considering the role of pyridoxine, thus PLP, in the synthesis of γ-aminobutyric acid and its easy and safe administration, prospective studies on pyridoxine supplementation in patients with eSE are needed.
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Affiliation(s)
- Clio Rubinos
- Department of Neurology, Division of Critical Care Neurology and Division of Epilepsy, University of North Carolina at Chapel Hill, 170 Manning Drive, Physician Office, Chapel Hill, NC, USA.
| | - Maria Jose Bruzzone
- Department of Neurology, University of Florida, Gainesville, FL, CB 7025, USA
| | - Courtney Blodgett
- Department of Neurology, Division of Critical Care Neurology and Division of Epilepsy, University of North Carolina at Chapel Hill, 170 Manning Drive, Physician Office, Chapel Hill, NC, USA
| | - Carolyn Tsai
- Department of Neurology, Division of Critical Care Neurology and Division of Epilepsy, University of North Carolina at Chapel Hill, 170 Manning Drive, Physician Office, Chapel Hill, NC, USA
| | - Puja Patel
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Rachel Hianik
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Rakesh Jadav
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Chuning Liu
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Hongtu Zhu
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Susan E Wilson
- Department of Neurology, Division of Critical Care Neurology and Division of Epilepsy, University of North Carolina at Chapel Hill, 170 Manning Drive, Physician Office, Chapel Hill, NC, USA
| | - Casey Olm-Shipman
- Department of Neurology, Division of Critical Care Neurology and Division of Epilepsy, University of North Carolina at Chapel Hill, 170 Manning Drive, Physician Office, Chapel Hill, NC, USA
| | - Rick Meeker
- Department of Neurology, Division of Critical Care Neurology and Division of Epilepsy, University of North Carolina at Chapel Hill, 170 Manning Drive, Physician Office, Chapel Hill, NC, USA
| | - Lawrence J Hirsch
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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4
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Rane S, Elrahi S, Villarreal J, Zulfi H, Fang X, Graf D, Rodriguez R, Garza A, Thottempudi N, Rai P, Masel T. Low Serum Pyridoxine Levels Worsen Seizure Control in Adult Epilepsy Patients. Cureus 2022; 14:e25669. [PMID: 35812624 PMCID: PMC9256010 DOI: 10.7759/cureus.25669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Vitamin B6 (pyridoxine) is an important cofactor in the process by which glutamic acid decarboxylase (GAD) converts the excitatory, pro-epileptogenic neurotransmitter, glutamate, into the inhibitory, anti-epileptogenic neurotransmitter, gamma-aminobutyric acid (GABA). This concept has been established in infants with pyridoxine-dependent epilepsy as well as adult patients with other epilepsy subtypes who presented with medication-resistant status epilepticus, with both patient groups experiencing cessation of seizure activity following pyridoxine administration. Given our knowledge of the role of vitamin B6 in the conversion of glutamate to GABA, its effect on seizure control in infants with specific epilepsy subtypes, reports of adult-onset seizures associated with vitamin B6 deficiency, and vitamin B6’s role in terminating status epilepticus in adult patients with other types of epilepsy, we suspect that low vitamin B6 levels in adult epilepsy patients may correlate with poor seizure control across all epilepsy subtypes. This study seeks to determine whether there is a relationship between pyridoxine levels and the level of seizure control in adults with epilepsy, regardless of their seizure type. Methods: After obtaining institutional review board approval, we prospectively enrolled 32 patients (age range: 25-57 years) with epilepsy who presented to our clinic. Patients who did not meet the study criteria or who were diagnosed with psychogenic non-epileptic seizures (PNES) were excluded from the study (n = 2). Patients were classified as well-controlled (WC) or poorly controlled (PC) based on the absence or presence of a seizure within the last three months, respectively. After classification as WC or PC, pyridoxine serum levels and anti-seizure medication (ASM) levels were drawn in that clinic visit, following patient consent. All patients were contacted regarding pyridoxine and serum ASM levels, and patients that were found to be deficient in pyridoxine were treated with appropriate supplementation. At the end of the recruitment period, we performed analyses to determine if there was a statistically significant relationship between PC status and serum pyridoxine levels. Results: Of 32 patients, two patients were diagnosed with psychogenic non-epileptic events and were subsequently excluded. Of 30 patients, 10 had PC epilepsy. Median (interquartile range) serum B6 levels were 35.8 (26.8-54.2) in patients with WC epilepsy and 17.5 (10.1-41.3) in patients with PC epilepsy (P = 0.11). In the PC group, 6/10 (60%) of the patients demonstrated low serum pyridoxine compared to 3/20 (15%) in the WC group (P = 0.03). Conclusion: There was a statistically significant relationship between serum pyridoxine levels and seizure control. If appropriate, pyridoxine supplementation should be considered, especially in critically ill adult patients with refractory or PC seizures despite good adherence to ASMs.
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The epidemiology, impact, and diagnosis of micronutrient nutritional dermatoses. Part 2: B-complex vitamins. J Am Acad Dermatol 2022; 86:281-292. [DOI: 10.1016/j.jaad.2021.06.900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
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Steriade C, Titulaer MJ, Vezzani A, Sander JW, Thijs RD. The association between systemic autoimmune disorders and epilepsy and its clinical implications. Brain 2021; 144:372-390. [PMID: 33221878 DOI: 10.1093/brain/awaa362] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
Systemic autoimmune disorders occur more frequently in patients with epilepsy than in the general population, suggesting shared disease mechanisms. The risk of epilepsy is elevated across the spectrum of systemic autoimmune disorders but is highest in systemic lupus erythematosus and type 1 diabetes mellitus. Vascular and metabolic factors are the most important mediators between systemic autoimmune disorders and epilepsy. Systemic immune dysfunction can also affect neuronal excitability, not only through innate immune activation and blood-brain barrier dysfunction in most epilepsies but also adaptive immunity in autoimmune encephalitis. The presence of systemic autoimmune disorders in subjects with acute seizures warrants evaluation for infectious, vascular, toxic and metabolic causes of acute symptomatic seizures, but clinical signs of autoimmune encephalitis should not be missed. Immunosuppressive medications may have antiseizure properties and trigger certain drug interactions with antiseizure treatments. A better understanding of mechanisms underlying the co-existence of epilepsy and systemic autoimmune disorders is needed to guide new antiseizure and anti-epileptogenic treatments. This review aims to summarize the epidemiological evidence for systemic autoimmune disorders as comorbidities of epilepsy, explore potential immune and non-immune mechanisms, and provide practical implications on diagnostic and therapeutic approach to epilepsy in those with comorbid systemic autoimmune disorders.
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Affiliation(s)
- Claude Steriade
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Maarten J Titulaer
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annamaria Vezzani
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, Bucks, UK.,Stichting Epilepsie Instellingen Nederland - (SEIN), Heemstede, The Netherlands
| | - Roland D Thijs
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Stichting Epilepsie Instellingen Nederland - (SEIN), Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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7
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Neurologic Manifestations of Systemic Disease: Seizure. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Gwathmey KG, Grogan J. Nutritional neuropathies. Muscle Nerve 2019; 62:13-29. [PMID: 31837157 DOI: 10.1002/mus.26783] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/07/2019] [Accepted: 12/07/2019] [Indexed: 12/17/2022]
Abstract
Neuropathies associated with nutritional deficiencies are routinely encountered by the practicing neurologist. Although these neuropathies assume different patterns, most are length-dependent, sensory axonopathies. Cobalamin deficiency neuropathy is the exception, often presenting with a non-length-dependent sensory neuropathy. Patients with cobalamin and copper deficiency neuropathy characteristically have concomitant myelopathy, whereas vitamin E deficiency is uniquely associated with a spinocerebellar syndrome. In contrast to those nutrients for which deficiencies produce neuropathies, pyridoxine toxicity results in a non-length-dependent sensory neuronopathy. Deficiencies occur in the context of malnutrition, malabsorption, increased nutrient loss (such as with dialysis), autoimmune conditions such as pernicious anemia, and with certain drugs that inhibit nutrient absorption. When promptly identified, therapeutic nutrient supplementation may result in stabilization or improvement of these neuropathies.
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Affiliation(s)
| | - James Grogan
- University of Virginia, Charlottesville, Virginia
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9
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Mateos R, García-Zafra A, Vera-López S, San Andrés MP, Díez-Pascual AM. Effect of Graphene Flakes Modified by Dispersion in Surfactant Solutions on the Fluorescence Behaviour of Pyridoxine. MATERIALS (BASEL, SWITZERLAND) 2018; 11:E888. [PMID: 29799471 PMCID: PMC6025388 DOI: 10.3390/ma11060888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 11/16/2022]
Abstract
The influence of graphene (G) dispersions in different types of surfactants (anionic, non-ionic, and cationic) on the fluorescence of vitamin B₆ (pyridoxine) was studied. Scanning electron microscopy (SEM) was used to evaluate the quality of the G dispersions via measuring their flake thickness. The effect of surfactant type and concentration on the fluorescence intensity was analyzed, and fluorescence quenching effects were found for all of the systems. These turn out to be more intense with increasing both surfactant and G concentrations, albeit they do not depend on the G/surfactant weight ratio. For the same G concentration, the magnitude of the quenching follows the order: cationic > non-ionic ≥ anionic. The cationic surfactants, which strongly adsorb onto G via electrostatic attraction, are the most effective dispersing agents and they enable a stronger interaction with the zwitterionic form of the vitamin; the dispersing power improves with increasing the surfactant chain length. The fit of the experimental data to the Stern-Volmer equation suggests either a static or dynamic quenching mechanism for the dispersions in non-ionic surfactants, while those in ionic surfactants show a combined mechanism. The results that were obtained herein have been compared to those that were reported earlier for the quenching of another vitamin, riboflavin, to elucidate how the change in the vitamin structure influences the interactions with G in the surfactant dispersions.
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Affiliation(s)
- Rocío Mateos
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, Faculty of Sciences, Alcalá University, 28871 Alcalá de Henares, Madrid, Spain.
| | - Alba García-Zafra
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, Faculty of Sciences, Alcalá University, 28871 Alcalá de Henares, Madrid, Spain.
| | - Soledad Vera-López
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, Faculty of Sciences, Alcalá University, 28871 Alcalá de Henares, Madrid, Spain.
| | - María Paz San Andrés
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, Faculty of Sciences, Alcalá University, 28871 Alcalá de Henares, Madrid, Spain.
| | - Ana María Díez-Pascual
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, Faculty of Sciences, Alcalá University, 28871 Alcalá de Henares, Madrid, Spain.
- Institute of Chemistry Research, "Andrés M. del Río" (IQAR), University of Alcalá, Ctra. Madrid Barcelona, Km. 33.6, 28871 Alcalá de Henares, Madrid, Spain.
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10
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Kamel AY, Dave NJ, Zhao VM, Griffith DP, Connor MJ, Ziegler TR. Micronutrient Alterations During Continuous Renal Replacement Therapy in Critically Ill Adults: A Retrospective Study. Nutr Clin Pract 2017; 33:439-446. [PMID: 28727945 DOI: 10.1177/0884533617716618] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Continuous renal replacement therapy (CRRT) is commonly used to provide renal replacement therapy in the intensive care unit. Limited published data suggest that CRRT may lead to depletion of water-soluble vitamins and trace elements. The goal of this study was to identify the incidence of trace element and vitamin deficiencies in critically ill patients during CRRT. MATERIALS AND METHODS This study is based on a retrospective chart review of patients who were referred to Emory University Hospital's nutrition support services and had at least 1 serum micronutrient level measured during CRRT (thiamin, pyridoxine, ascorbic acid, folate, zinc, and copper) between April 1, 2009, and June 1, 2012. RESULTS Seventy-five patients were included in the study. Nine of 56 patients (16%) had below-normal whole blood thiamin concentrations, and 38 of 57 patients (67%) had below-normal serum pyridoxine levels. Serum ascorbic acid and folate deficiencies were identified among 87% (13 of 15) and 33% (3 of 9) of the study patients, respectively. Nine of 24 patients had zinc deficiency (38%), and 41 of 68 patients had copper deficiency (60%). Of the 75 total subjects, 60 patients (80%) had below-normal levels of at least 1 of the micronutrients measured. CONCLUSIONS The incidence of various micronutrient deficiencies in critically ill patients who required CRRT was higher than previously reported. Prospective studies are needed to determine the impact of CRRT on micronutrient status and the potential clinical and metabolic efficacy of supplementation in the intensive care unit setting.
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Affiliation(s)
- Amir Y Kamel
- Department of Pharmacy, UF Health and University of Florida, Gainesville, Florida, USA
| | - Nisha J Dave
- Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Vivian M Zhao
- Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Daniel P Griffith
- Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Michael J Connor
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Emory Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA
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11
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Dave HN, Eugene Ramsay R, Khan F, Sabharwal V, Irland M. Pyridoxine deficiency in adult patients with status epilepticus. Epilepsy Behav 2015; 52:154-8. [PMID: 26418265 DOI: 10.1016/j.yebeh.2015.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/12/2015] [Indexed: 11/18/2022]
Abstract
An 8-year-old girl treated at our facility for superrefractory status epilepticus was found to have a low pyridoxine level at 5 μg/L. After starting pyridoxine supplementation, improvement in the EEG for a 24-hour period was seen. We decided to look at the pyridoxine levels in adult patients admitted with status epilepticus. We reviewed the records on patients admitted to the neurological ICU for status epilepticus (SE). Eighty-one adult patients were identified with documented pyridoxine levels. For comparison purposes, we looked at pyridoxine levels in outpatients with epilepsy (n=132). Reported normal pyridoxine range is >10 ng/mL. All but six patients admitted for SE had low normal or undetectable pyridoxine levels. A selective pyridoxine deficiency was seen in 94% of patients with status epilepticus (compared to 39.4% in the outpatients) which leads us to believe that there is a relationship between status epilepticus and pyridoxine levels.
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Affiliation(s)
- Hina N Dave
- Department of Neurology, Ochsner Medical Center, New Orleans, LA, USA
| | | | - Fawad Khan
- Department of Neurology, Ochsner Medical Center, New Orleans, LA, USA
| | - Vivek Sabharwal
- Department of Neurology, Ochsner Medical Center, New Orleans, LA, USA
| | - Megan Irland
- Department of Neurology, Ochsner Medical Center, New Orleans, LA, USA
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12
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Lee DG, Lee Y, Shin H, Kang K, Park JM, Kim BK, Kwon O, Lee JJ. Seizures Related to Vitamin B6 Deficiency in Adults. J Epilepsy Res 2015; 5:23-4. [PMID: 26157671 PMCID: PMC4494992 DOI: 10.14581/jer.15006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/02/2015] [Indexed: 11/12/2022] Open
Abstract
Vitamin B6 is closely associated with functions of the nervous, immune, and endocrine systems. Its deficiency may result in neurological disorders including convulsions and epileptic encephalopathy. Until today, this has only been reported in infants, children, and critically ill adult patients. We report a case of a 36year-old man with chronic alcoholism who presented with seizures after gastrointestinal disturbance. His seizures persisted even after treatment with antiepileptic drugs, but eventually disappeared after administration of pyridoxine. Hence, vitamin B6 deficiency may cause seizures in adult patients with chronic alcoholism.
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Affiliation(s)
- Dong-Gun Lee
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Yeonkyung Lee
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Hyeeun Shin
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Kyusik Kang
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Ohyun Kwon
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jung-Ju Lee
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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13
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14
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Tong Y. Seizures caused by pyridoxine (vitamin B6) deficiency in adults: A case report and literature review. Intractable Rare Dis Res 2014; 3:52-6. [PMID: 25343127 PMCID: PMC4204538 DOI: 10.5582/irdr.2014.01005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/15/2014] [Indexed: 11/05/2022] Open
Abstract
Pyridoxine (vitamin B6) deficiency is a recognised cause of intractable seizures in neonates. However, pyridoxine deficiency related seizures in adults were rarely reported. This article reports a case of a 79 year old lady who suffered from new-onset seizures and was successfully treated with vitamin B6. The patient had chronic renal disease and weight loss due to anepithymia following a pelvic fracture. This article also reviews literatures of seizures caused by pyridoxine deficiency in adults. Seizures caused by vitamin B6 deficiency in adults may result from dietary deficiency, liver disease, pregnancy and certain medications and can be easily treated by vitamin B6 with excellent outcome. Clinicians should consider vitamin B6 deficiency as a potential aetiology of seizures, even in patients who suffer from other underlying diseases which can cause seizures.
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Affiliation(s)
- Yisha Tong
- Vascular Surgery Unit, Austin Hospital, University of Melbourne, Melbourne, Australia
- Address correspondence to: Dr. Yisha Tong, Vascular Surgery Unit, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne 3084, Australia. E-mail:
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Refractory epileptic seizures due to vitamin B6 deficiency in a patient with Parkinson's disease under duodopa® therapy. J Neural Transm (Vienna) 2012; 120:315-8. [PMID: 22798026 DOI: 10.1007/s00702-012-0856-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 06/24/2012] [Indexed: 01/08/2023]
Abstract
Levodopa/carbidopa intestinal gel (LCIG) infusion for the treatment of advanced Parkinson's disease (PD) has been suspected to provoke polyneuropathy in conjunction with vitamin B6, B12 and folate deficiency and elevated homocysteine levels. We describe a PD patient under LCIG therapy developing refractory epileptic seizures obviously promoted by vitamin B6 deficiency.
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Mintzer S, Skidmore CT, Sperling MR. B-vitamin deficiency in patients treated with antiepileptic drugs. Epilepsy Behav 2012; 24:341-4. [PMID: 22658435 DOI: 10.1016/j.yebeh.2012.04.132] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/10/2012] [Accepted: 04/21/2012] [Indexed: 11/18/2022]
Abstract
Enzyme-inducing antiepileptic drugs (AEDs) produce many alterations in metabolism, including vitamin levels. Whether they produce clinically relevant deficiency of B vitamins has rarely been assessed. We obtained B-vitamin levels in patients who were being converted from an inducing AED (phenytoin or carbamazepine) to a non-inducing AED (levetiracetam, lamotrigine, or topiramate), with measurements both before and ≥ 6 weeks after the switch. A group of normal subjects underwent the same studies. Neither folate nor B12 deficiency was seen in any patient. Vitamin B6 deficiency was found in 16/33 patients (48%) taking inducers, compared to 1/11 controls (9%; p=0.031). After switch to non-inducers, only 7 patients (21%) were B6 deficient (p=0.027). The incidence of deficiency was similar regardless of which inducing or non-inducing AED was being taken. Our findings demonstrate that treatment with inducing AEDs commonly causes pyridoxine deficiency, often severe. This could conceivably contribute to the polyneuropathy sometimes attributed to older AEDs, as well as other chronic heath difficulties.
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Affiliation(s)
- Scott Mintzer
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
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