Epilepsy and comorbidity: infections and antimicrobials usage in relation to epilepsy management

Abstract

Infections are probably the most common preventable cause of epilepsy worldwide. There are concerns that endemic infections and infestations, such as malaria and neurocysticercosis, could be responsible for the increased incidence of epilepsy in the developing world. Cases of epilepsy associated with neurocysticercosis are also being seen increasingly in developed countries due to migration from, and travel to, endemic areas. When prescribing antimicrobial agents in patients with epilepsy a number of issues need to be considered, such as potential adverse effects on seizure control and interactions with concomitant antiepileptic drugs (AEDs). Some antimicrobial agents, including penicillins, cephalosporins, carbapenems, quinolones and antimalarials, can have proconvulsant activity and may precipitate seizures, even in patients who do not have epilepsy. Moreover, many antimicrobials increase or decrease the plasma levels of AEDs, whereas some AEDs may adversely affect the efficacy of antimicrobials.

Clinical Evaluation of Superficial Fungal Infections in Children

“…Fungal enfeksiyonların diyabetli hastalarının %10-60'ında bulunduğu bildirilmiştir (8). Epilepsi hastalarında ise etyolojide sıklıkla suçlanan enfeksiyonlar nedeniyle bu popülasyonda antibiyotiklerin kullanımı çok daha yüksek orandadır (9). Bizim hastalarımızda da bu bulguları destekler şekilde akciğer tüberkülozu, ekstrofia vesica, ektodermal displazi, epilepsi, gelişme geriliği, hipospadias, obezite, diyabet, pakiyonisi konjenita, prematürite ve rinosinuzit gibi gibi eşlik eden hastalıklar olduğu görüldü.…”

Neurological comorbidity and epilepsy: implications for treatment

“…However, in patients with CNS infections, this risk may be higher, even though, in the vast majority of cases, it is not possible to establish a cause-effect relationship because of the concomitant effect of the concurrent disease (81).…”

“…To prevent these complications, among those agents appropriate for a given indication, the antimicrobial with the lowest epileptogenic potential should be selected, and, for renally eliminated drugs, dosage should be adjusted according to the degree of renal impairment. Attention should be given to concomitant risk factors such as hyponatremia and early signs of neurotoxicity (81).…”

Changes in medication associated with epilepsy‐related hospitalisation: a case‐crossover study

“…Since a substantial number (13%) of the introduced noninteracting drugs were antibiotics, the occurrence of infections and subsequent triggering of an epileptic event can also explain the observed association. 27 The results of this study should be interpreted in the light of its limitations. Our small sample size was one of our main limitations.…”