IEC 2025 | The impact of climate change on epilepsy management and anti-seizure medication

This question is important because the medications that are used for the people with epilepsy are called, firstly, anti-seizure medications. And these medications, if we approach this question pharmacologically, these anti-seizure medications have a narrow therapeutic index and they are the drugs that we always need to consider their adverse reactions or their therapeutic failure in terms of people with epilepsy. So in terms of climate change, firstly, we need to remember that all these medications, including anti-seizure medications, could be affected by exposure to high temperature and humidity. Their pharmacological stability may change. Their pharmacokinetic characteristics may change. Even their pharmacodynamic characteristics may change after exposure to high temperature and humidity. But it is difficult to say, to give a clear answer to each of these anti-seizure medications, because there are more than 30 available anti-seizure medications today. And we do not have evidence-based literature for most of them. But we know, for example, carbamazepine, for example, valproate, for example, levetiracetam, that these anti-seizure medications, their pharmacological stability may change with exposure to high temperature and humidity. If we think about the pharmacokinetics, again, the adverse weather events such as heat waves, cold spells, could play an important role in changing, in alteration of pharmacokinetics of these medications. Again, there is scarce information regarding this question, but we can give some examples of this, for example, for phenytoin or for example, for carbamazepine and valproate. Again, there are some studies that have shown the changes in their blood levels during summertime, for example, during the hot days, extremely hot days, the serum concentration, blood concentration of these drugs may change, may decrease. And this is important for people with epilepsy because they use these anti-seizure medications to control their seizures, which is very important for their quality of life. And therapeutic inefficacy may occur if the blood levels of these medications decrease. And also adverse drug reactions are very important. There are some case reports shown for lamotrigine photosensitivity reactions, also for phenytoin rash. And during the, again, hot days under the sunlight, exposure to sunlight, the adverse reactions, the photosensitivity or rash reactions may occur. I mean, this reaction, the risk for this reaction increases during these hot days and under exposure to long periods of sunlight, let’s say. So anti-seizure medications are important medications because we need to follow blood levels of anti-seizure medications during not only for adverse weather events, but for also the other, all the seasons, let’s say, because they have a narrow therapeutic window. This means that those changes or the environmental changes may affect their levels, blood levels, and their blood levels, if change, then the people with epilepsy may experience a seizure, a disruption in seizure control, or may experience some adverse drug reactions.

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