EAN 2025 | The impact of adverse weather events and temperature fluctuations on individuals with epilepsy

Well, these adverse weather events and temperature fluctuations are becoming more frequent and severe. And these rising temperatures cause climate changes. And climate changes influence the occurrence of stroke and epileptic seizures. So they have direct and indirect consequences for people living with these conditions. When it comes to epilepsy, these temperature extremes, humidity, heat waves, atmospheric pressure can influence the seizure frequency. It was shown that during summer months, there is an increase in seizure frequency compared to winter months. So basically, these adverse weather events or the effect of global warming can play a significant role in triggering the seizure precipitance or they can alter the risk of epilepsy. Also, these extreme temperatures may affect the quality of life in epilepsy. This is strongly associated with seizure control, and seizure control is actually related to the adherence and supply of anti-seizure medication. But sometimes these adverse weather events can disrupt the supply chains, and this can potentially lead to compromised seizure control. People with epilepsy suffer from comorbid conditions such as depression, anxiety, migraine, dementia, heart disease, and this is more frequent compared to the general population, and also, people with drug-resistant epilepsy are often on polytherapy, so that is why during these extreme temperatures or adverse weather events, the supply chains can be disrupted, and therefore, this can potentially lead to compromised seizure control. Also, extreme temperatures affect the pharmacological characteristics of anti-seizure medication, especially extreme high temperatures and extreme humidity. Anti-seizure medication have very narrow therapeutic windows, and even slight variation in their pharmacokinetics can lead to therapeutic failure or unwanted events. Again, the physico-chemical stability of anti-seizure medication can be affected by high temperature. And that is why specific storage temperatures are required for anti-seizure medication. They usually range between 15 to 30 degrees, except for the liquid formulations of gabapentin or lorazepam that require refrigeration. Also, some drugs, anti-seizure medication can be light-sensitive and therefore it is recommended that they are stored in airtight and light-resistant containers in order to sustain their stability. The other thing that we need to be aware is that sometimes these medications are kept in so-called dose administration aids in order to improve the adherence in chronic drug treatment. However, in countries with tropical climate or in desert regions, these aids can actually compromise the stability of the drugs because they cause reduced bioavailability of the drugs. And then patients also might experience increased frequency of the seizures. It is also important to have in mind that some hospitals do not have their own laboratories to investigate the dosage of the anti-seizure medication in the blood. And therefore, sometimes these blood samples are kept in conditions that may influence their level in the blood. So we need to know that these serum samples should be stored in a temperature of 4 to 8 degrees for a maximum of 7 days in order to maintain the quality of the samples, in order to achieve accurate results for the individuals, because the dosage of the drugs is sometimes related to the blood levels of these drugs. And what would be the suggested mechanism of these adverse responses of the drugs is that some drugs actually cause extreme perspiration, and some drugs actually reduce the perspiration during extremely hot weather. And also, the suggested mechanism is a change in the activity of the hepatic cytochrome P450 enzymes. So basically, most of these anti-seizure medications are metabolized in the liver, and therefore, during extreme temperatures, sometimes changes in the activity of the liver enzymes can happen, and therefore, this actually affects the metabolism of the drugs. But not only hot temperatures can cause changes in the drug response of anti-seizure medication. There are some studies that actually showed that during spring also, sometimes we can see, this study was performed in Russia, so we can see a lower minimum and maximum concentration of the drugs such as carbamazepine or valproic acid, and this also led to increased number of seizures and also increased severity of the seizures. And another thing that we need to bear in mind is that sometimes extreme temperatures can actually increase the incidence of adverse drug reactions. There are examples in the literature that there was a marked increase in the phenytoin rash incidence during the summer compared to other seasons. This study was performed in the United States of America, and it was observed that when the drug was introduced during the summer months of June, July, and August, there were highest rates for cutaneous reaction within the three weeks of initiation of the therapy with phenytoin. However, when treatment was initiated in the winter months of December, January, and February, then no reactions were seen. And the potential mechanism was attributed to the protective effects of a more activated immune system during the winter. Another example of the climatic factors on the anti-seizure medication-induced cutaneous adverse drug reaction was photosensitivity that was associated with the usage of lamotrigine. And this was a case report that was described in a patient after exposure to sunlight or solarium usage. The patient developed a toxic epidermal necrolysis, and this condition resolved after the discontinuation of lamotrigine. So basically, there are some research gaps that need to be addressed, such as the physical chemical stability of the drugs. We need to look more into the altered liver enzyme activity and other key factors in the drug metabolism. Also, to look for more vulnerable groups such as the elderly and children and to see what is the impact of comorbidities and comedication in patients with epilepsy.

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