Predictors of successful Ramadan fasting in Muslim patients with epilepsy: A prospective study

• Published in: Seizure (London, England) Vol. 80; pp. 67 - 70
• Main Authors: Magdy, Rehab, kishk, Nirmeen A., Abokrysha, Noha T., Ramzy, Gihan M., Rizk, Hoda Ibrahim, Hussein, Mona
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-08-2020
• Subjects: Breakthrough seizures; Epilepsy; Fasting - psychology; Humans; Islam; Prospective Studies; Ramadan fasting; Sleep; Sleep duration; Ramadan fasting; Epilepsy; Breakthrough seizures; Sleep duration
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2020.04.012

•Neurologists should counsel their MPWE who wish to fast Ramadan on the risks and precautions of fasting.•Maximum seizure freedom before Ramadan and sleep duration hours are independent predictors of successful Ramadan fasting.•The probability of successful fasting increases by 10%, with every extra week of being seizure free before Ramadan.•The probability of successful fasting increases by 30%, with every extra hour of sleep.
Ramadan fasting represents a challenge for both Muslim patients with epilepsy (MPWE) as well as their treating neurologists who aim to minimize the risk of fasting-related seizures. Several factors may contribute to the risk of fasting-related seizures such as the half-life of antiepileptic drugs (AEDs), seizure control before Ramadan, and sleep fragmentation. The aim of this work was to investigate these factors.
An observational prospective study included all MPWE who completed Ramadan fasting in 2019, about 16 h per day for 30 days. They were assessed regarding seizure control, AEDs, and sleep alterations using The Pittsburgh Sleep Quality Index.
The study included 430 MPWE. The majority of patients (75.58%) completed Ramadan fasting without breakthrough seizures. Patients achieved successful Ramadan fasting were significantly younger, had shorter disease duration, longer periods of seizure freedom before Ramadan, more efficient and longer sleep hours. There was no significant difference between patients receiving monotherapy regimens with short versus intermediate long t½. Maximum seizure freedom before Ramadan and sleep hours were identified as independent predictors of successful Ramadan fasting, using multivariate analysis. Every extra week of being seizure free before Ramadan and every extra hour of sleep was associated with an increase in the probability of successful Ramadan fasting by 10% and 30%, respectively.
Neurologists should guide their MPWE who wish to fast Ramadan about the risks and precautions. Proper seizure control and ensuring adequate sleep duration can increase the probability of a successful Ramadan fasting.