He was again treated with potassium phosphate and given 1000 mg of oral levetiracetam. He worked in a steel mill, primarily involved in moving inventory, and had no exposure to welding or other chemical toxins. 3540 Crain Highway, Suite 675,Bowie, MD 20716, 2023 Epilepsy Foundation, is a non-profit organization with a 501(c)(3) tax-exempt status. This case also highlights the importance of obtaining phosphorus and vitamin D levels in SARS-CoV-2-infected patients with seizures. Ultrasound of her neck did not show any thyroid or parathyroid abnormality. have reported a wide range of derangements in the electrolyte levels obtained from 11,635SARS-CoV-2-affected subjects. Endocrinology workup included genetic testing and interval measurements of serum phosphate, calcium, alkaline phosphatase, parathyroid hormone,25-hydroxyvitamin D, 1,25-hydroxyvitamin D, fibroblast growth factor23, urine calcium, and the ratio of tubular maximum reabsorption rate of phosphate-to-glomerular filtration rate (TmP/GFR). Hypocalcemia is a frequently encountered biochemical abnormality. The diagnosis is more easily reached in severe deficiencies with some of the classical (typical) symptoms and bone deformities. Are There Medications That Cause Vitamin D Deficiency? - HealthCentral Too much exposure to the sun's rays can be damaging. The sunlight has to fall directly on to bare skin (through a window is not enough). 2012 Apr-Jun; 3(2): 118126. If you take large doses of vitamin D, you may experience stomach pain, loss of . A study published in 2012 showed that correcting Vit. Review the following levels for 25-hydroxy vitaminDbefore speaking with your healthcare provider: Multiply ng/mL by 2.5 to convert to nmol/liter.3. Mark J Bolland, PhD et al; Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis, The Lancet, October 2018. So, vitamin D deficiency is more likely to develop in the following groups of people: Vitamin D deficiency is more likely to occur in people who follow a strict vegetarian or vegan diet, or a non-fish-eating diet. Gaasbeek A, Meinders AE. A review of records related to subsequent outpatient workups revealed evaluations with the neurologist and endocrinologist. I've never noticed if this correlates to any increased seizures. The nurse told me to start giving 2000 units Vit D3 daily.CVS has 2000 unit gummies :-)I don't know if a deficiency could cause an increase in seizures. Calcium and vitamin D supplements have also helped to prevent hip fractures among geriatric population. A combined deficiency at the level of 19.3 (30-80 ng/mL) was reported only after the patients discharge. This case also highlights the importance of obtaining phosphorus and vitamin D levels in SARS-CoV-2-infected patientswith seizures. Calcium homeostasis is maintained by the coordinated actions of PTH and vitamin D. PTH stimulates calcium resorption from the renal tubules and release of calcium from the bones. Vitamin D deficiency is associated with sudden cardiac death combined with cardiovascular events and mortality in hemodialysis patients. The effect of a single, large bolus of vitamin D in healthy adults over the winter and following year: a randomized, double-blind, placebo-controlled trial. Harrison's principles of internal medicine. Rarely, some people without any other risk factors or diseases become deficient in vitamin D. It is not clear why this occurs. As a library, NLM provides access to scientific literature. The .gov means its official. The advantage of the higher-dose treatment is that the deficiency improves quickly, which is very important in growing children or people who have very low levels. These processes consume ATP as the inflammatory response and production of immune cells need energy. Bethesda, MD 20894, Web Policies Extremely high levels of vitamin D can cause kidney failure, irregular heartbeat, and even death. What is hypocalcemia? Each person was checked during the study to make sure that the vitaminD levels normalized and didnt become toxic. de Oliveira Iglesias SB, Pons Leite H, de Carvalho WB. We hypothesize that the lowerphosphorus levels secondary to a SARS-CoV-2 infection in our patient led to a decrease in seizure threshold, thereby resulting in his seizures. 2012 Apr-Jun, Vitamin D Deficiency including Osteomalacia and Rickets, Calcium and ergocalciferol tablets (CalciErgo, A1 Cal-E), Calcium with colecalciferol (A1-Cal D3, AaceCa D3, Accrete D3, Adcal-D3, Cacit D3, Calceos, Calcichew-D3, Calci-D, Calfovit D3, Colekal-D3, Evacal D3, Kalcipos-D, Natecal D3, Sunvit-D3, TheiCal-D3), How to boost your vitamin D levels this winter, Chemical found in soap and toothpaste linked to osteoporosis, Why clean eating could be bad for your bones. Taking vitamin D can increase levels of calcium in the blood, and too much calcium can cause side effects. Vitals were normal at presentation and physical examination was significant for a 2-cm superficial occipital scalp laceration and postictal confusion. As a person who has only used B vitamins (vitamin B6 (Pyridoxine) for over 41 yrs - prescribed) to control my seizures this topic is of intrest to me. It has been associated with electrolyte abnormalities. This can happen if you don't eat enough foods containing vitamin B-12 and folate, or if your body has trouble absorbing or processing these vitamins. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. Height is usually affected more than weight. sharing sensitive information, make sure youre on a federal Can borderline vitamin D levels cause seizures | Epilepsy Foundation We were told today that our daughter's bloodtest showed a Vit D deficiency. Programs Briefs | Epilepsy Foundation, Discrimination in Federally Funded Programs Briefs, First Responders and Seizure Management Briefs, Resources and Seizure Action Plans for Summer Camp, Explaining Epilepsy to Friends and Family, Epilepsy Foundation Individual and Family Services, About Research and Funding at Epilepsy Foundation, The Epilepsy Learning Healthcare System (ELHS), Access the Rare Epilepsy Network Registry, #AimForZero: Striving Toward a Future Free from Sudden Unexpected Death in Epilepsy, Advocacy: Access Prescription Medications, Advocacy: Affordable Comprehensive Health Coverage, Teens Speak Up! Babies having 500 ml or more of formula milk per day do not need supplements, as formula milk already has vitamin D added. Drechsler C. et.al. All content published within Cureus is intended only for educational, research and reference purposes. Seizures are an uncommon presentation of SARS-CoV-2 infections. government site. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2020;76:13391349. Seizures, Vitamin D Deficiency, and Severe Hypophosphatemia - PubMed by OmegaQuant | Mar 8, 2022 | Brain Health, Heart Health, Vitamin D Neuropathy is a common condition estimated to affect between 25-30% of Americans at some point in their lives. and that vitamin D deficiency causes . On the patients second presentation for recurring seizures, he again demonstrated moderate hypophosphatemia despite compliance with the anti-seizure medication levetiracetam. Liamis G, Milionis HJ, Elisaf M. A review of drug-induced hypocalcemia. Muscle problems, which can be experienced as numbness in your extremities, along with other symptoms, are an indication of having too much vitamin D in your system. Chest radiograph during the first visit, Black arrows indicate bibasilar atelectasis, MeSH Once vitamin D deficiency has been treated, the body's stores of vitamin D have been replenished. It would be very useful to know of any cases related to the above as my 11 year old son other wise normal and no family history of epilepsy has had 3 seizures in the last three months and his blood results show severe Vitamin D deficiency. In the UK, sunshine isn't strong enough to allow you to make your own vitamin D in winter. In adults, low levels of vitamin D can increase your risk of osteoporosis, or thinning of the bones. Epub 2020 Nov 21. Metabolic mechanisms, however, are less commonly described. Vitamin deficiency anemia - Symptoms & causes - Mayo Clinic She was given single bolus dose of intramuscular cholecalciferol (3 lakh IU) and intravenous 10% calcium gluconate (20 mL), followed by 10% calcium gluconate infusion (1.5 mg/kg/hour). This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register. Are over 65 (older adults are less efficient at producing vitamin D). Consent was obtained or waived by all participants in this study, National Library of Medicine 8600 Rockville Pike Muscle weakness may cause difficulty in climbing stairs or getting up from the floor or a low chair, or can lead to the person walking with a waddling pattern. sars-cov-2 infection, neurological manifestations in covid-19, vitamin-d deficiency, hypophosphatemia, recurrent seizures. In this article, we review the possible relationship between vitamin D and epilepsy from different aspects, including the action mechanism of vitamin D in the central nervous system and ecological and epidemiological . Many people who take antiepileptic drugs (AEDs) are vitamin D-deficient, potentially because some anti-seizure medications disrupt how the body processes vitamin D. Additionally, there is a high prevalence of osteoporosis in people with epilepsy, potentially because of vitamin D3 deficiency. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). D may play a role in seizures. Federal government websites often end in .gov or .mil. Dry, scaly skin . van Kempen TA, Deixler E. New onset acute symptomatic seizure and risk factors in coronavirus disease 2019: a retrospective multicenter study. In addition to potential seizure control, there is preliminary evidence that vitaminD may also play a role in sudden unexpected death in epilepsy (SUDEP). SARS-CoV-2 infections can result in vitamin D deficiency and hypophosphatemia, resulting in seizures, and hence should be treated with both replacement therapies and antiepileptic medications. Robin G Manappallil: Concept and design, manuscript preparation, review of literature and treating Physician; Raghuram Krishnan: Critical revision of manuscript and treating Cardiologist; Pradeep P Veetil: Critical revision of manuscript and treating Endocrine Surgeon; Ummer Karadan: Critical revision of manuscript and treating Neurologist; Harilal Nambiar: Critical revision of manuscript and treating Cardiothoracic Surgeon; Revathy Anil: Resident in-charge; Blessy Josephine: Resident in-charge, National Library of Medicine This is different from water-soluble vitamins such as vitamin C, which you need to consume every day. and transmitted securely. In children, being deficient in vitamin D can lead to a condition called rickets, where your bones are weak and soft and can become deformed (with bow legs). Hypoparathyroidism is an uncommon condition in which the body produces abnormally low levels of parathyroid hormone (PTH). After my first seizure I had bloodwork done and was found to have a very sever vitamin d deficiency. 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, Calcium, Hyperparathyroidism, Hypocalcemia, Seizure, Vitamin D. Cooper MS, Gittoes NJ. Gloth FM, Gundberg CM, Hollis WB, Haddad JG, Tobin JD. Hypervitaminosis D associated with a vitamin D dispensing error. My second seizure was 3 days after I started taking vitamin d supplements. For a better experience, please enable JavaScript in your browser before proceeding. Emergency Department, Trinity West Medical Center, Steubenville, USA, 2 CT of the head and the cervical spine, as well as radiographs of the chest done on the first visit, were all normal. Rickets: Definition, Symptoms, Causes & Treatment - Cleveland Clinic Book a private appointment with a local physio today. Hypocalcemic Seizure Due to Vitamin D Deficiency. I will ask my doc next week about what the body does with too much DI'm up for my yearly bloodwork. Seizures as Initial Manifestation of Vitamin D-Deficiency Rickets in a Hence, vitamin D deficiency leads to about 50% reduction in gastrointestinal absorption of calcium.7. There may indeed be a link -- A few studies have linked Vitamin D intake with a reduction in seizures, or speculate that low Vitamin D levels may lower seizure threshold: I just posted this on another page, but it bears repeating. Emergency Medicine, Emory University School of Medicine, Atlanta, USA. These foods include infant formula milk, most margarines and some cereals - you can check on the packet. This is more of a problem in the more northerly parts of the world (including the UK) where there is less sun. The patient was given 250-cc normal saline bolus with 15-mmol potassium phosphate rider. travel bug New Messages 495 Reaction score 1 Points 0 A 52-year-old male patient with questionable prior seizure history presented to the emergency department (ED) twice within eight days with recurring seizure episodes. Unauthorized use of these marks is strictly prohibited. JavaScript is disabled. My wife has had seizures now for almost two years and just recently had vitamin d levels tested and indicates a defficiency. The study included the following results: Although the study is small,it suggestsa major vitamin D deficiency may play a role in seizure control. The site is secure. Elderly people are unable to produce as much vitamin D. This leaves older people more at risk of vitamin D deficiency. In babies, B6 deficiency can even cause seizures. Summary. Known as the sunshine vitamin, sunshine remains the best source for receiving vitaminD. Dietary sources include meat, fish, dairy products, and, interestingly, mushrooms. Epilepsy Behav. Vitamin D and Epilepsy - Charlie Foundation However, it can take time (months) for bones to recover and for symptoms such as pain to improve. The metabolism and functions of vitamin D. DeLuca HF. Her level is 24. sharing sensitive information, make sure youre on a federal Lakatos P, Szcs A. Narula N, Joseph R, Katyal N, Daouk A, Acharya S, Avula A, Maroun R. Neurol Psychiatry Brain Res. Hyponatremia, hypochloremia, and hypocalcemia were frequently detected. In the UK they are also available on prescription to certain groups of people. Involuntary movements and seizures may rarely be the initial symptoms of Vitamin B12 deficiency. 8600 Rockville Pike Getting enough vitamin D is crucial for healthy bones and teeth. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. has found, "Significant changes in important body chemicals such as calcium and magnesium can cause seizures; so can a lack of certain vitamins. History obtained from the patient, his family, and his electronic medical recordsindicated that the patient had a past history of two seizure episodes - one in 2017 and again in 2019 - in the last five yearsdue to an unknown etiology. Laboratory examination at the first visit revealed SARS-CoV-2 positivity, hypokalemia, hypophosphatemia, and low vitamin D levels. Continued low levels of phosphorus in this patient support our observations of seizures secondary to SARS-CoV-2 infection, as the one-time phosphorus replacement and antiepileptic medications made no change in presentation. HHS Vulnerability Disclosure, Help Bone and mineral metabolism in healthy and disease. A review of neurological complications of COVID-19. Vitamin D deficiency means that there is not enough vitamin D in your body. Vitamin D deficiency is the most common cause of hypocalcemia and is due to inadequate exposure to sunlight, skin pigmentation, skin thinning with age, insufficient dietary intake, antiepileptic drugs, and malabsorption.1,79 Supplementation of vitamin D is essential to prevent rickets and osteoporosis. A rare case of acute symptomatic seizure, tetany and poor sensorium secondary to autosomal dominant hypocalcemia and hypercalciuria. So one person could take 8,000 D and only absorb a fraction, whereas another different person would absorb most of it. An official website of the United States government. Can Low Vitamin D Cause Neuropathy? Your doctor will discuss the dose and the best treatment schedule, depending on your situation, age, severity of the deficiency, etc. The baby had received his routine 5 month immunisations several hours earlier that day, which he tolerated well, and had no history of health or developmental concerns. This is because it is unlikely that any risk factor for vitamin D deficiency in the first place will have completely resolved. Vitamin D deficiency states are managed with weekly dosing of 50,000 IU for 312 weeks, followed by maintenance doses of 800 IU daily along with calcium.12 Large single doses of 250,000300,000 IU of vitamin D have shown to be effective at improving vitamin D levels and suppressing PTH concentrations.13,14. She was mainly confined to her house, and her diet was devoid of milk and milk products for many years. Vitamin D deficiency is a huge and growing problem in the United States. As a library, NLM provides access to scientific literature. I had a bad b-complex deficiency then started a year of intermuscular B complex injections and ended up with a slight surplus, so we stopped it and my body depleted within a few months. On presentation, she was conscious and oriented. Objective: Severe 25-hydroxyvitamin D (25(OH)D) deficiency can result in life-threatening presentations due to hypocalcemia leading to seizures and cardiac arrhythmias. However, there is no evidence that the normal use of sunscreen does actually cause vitamin D deficiency in real life. A simple blood test for vitamin D level can make the diagnosis. Multiple studies have shown that adult epilepsy patients can exhibit vitamin D deficiency. Federal government websites often end in .gov or .mil. The .gov means its official. Vitamin D Deficiency: Causes, Symptoms & Treatment - Cleveland Clinic These conditions include diabetes, coronary heart disease, breast cancer, bowel cancer, Alzheimer's disease and many others. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. The epileptic mechanism in SARS-CoV-2 still remains unclear. I just posted in another thread about possible benefits from cod liver oil (which has high Vitamin D). Everyone, especially children, should. Kuroda N. Hypophosphatemia: an update on its etiology and treatment. However, his vitamin D levels, the results of which came back only after his first discharge, were corrected only during his second visit. Computed tomography of the brain showed diffuse age-related atrophic changes, electroencephalogram was suggestive of diffuse cerebral dysfunction (high amplitude activity with slow waves in the posterior head regions which were bilaterally responsive to eye opening; no epileptiform activities were seen), and cerebrospinal fluid analysis was normal. Vitamin D is mostly made in the skin by exposure to sunlight. SARS-CoV-2 infections can result in vitamin D deficiency and hypophosphatemia, resulting in seizures, and hence shouldbe treated with both replacement therapies and antiepileptic medications. The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. With chronic and/or severe vitamin D deficiency, a decline in calcium and phosphorus absorption by your intestines leads to hypocalcemia (low calcium levels in your blood). Subsequently, hehad a sustained resolution of his recurrent seizure episodes. Lastly, we highlight the importance of ensuring follow-up for send-out tests drawn in the ED. Her postoperative period was uneventful and was discharged on day 10 of admission on oral calcium with vitamin D3 (500 mg/250 IU once daily), calcitriol (0.25 mg once daily), sodium valproate (300 mg twice daily), aspirin (75 mg once daily), clopidogrel (75 mg once daily), atorvastatin (40 mg once daily), glyceryl trinitrate sustained release (6.4 mg twice daily), torsemide (10 mg once daily), and metoprolol (25 mg twice daily). The information on this page is written and peer reviewed by qualified clinicians. To see if vitamin D3 has an impact on seizure frequency, we compared seizure numbers during a 90-day period before and after treatment onset. Diagnosis and management of hypocalcaemia. Calcium and vitamin D supplements have also helped to prevent hip fractures among . 1,6,7Department of Internal Medicine, Baby Memorial Hospital, Kozhikode, Kerala, India, 2Department of Cardiology, Baby Memorial Hospital, Kozhikode, Kerala, India, 3Department of Endocrine Surgery, Baby Memorial Hospital, Kozhikode, Kerala, India, 4Department of Cardiothoracic and Vascular Surgery, Baby Memorial Hospital, Kozhikode, Kerala, India, 5Department of Neurology, Baby Memorial Hospital, Kozhikode, Kerala, India. Severe vitamin D deficiency Insufficient calcium intake (malnutrition) Infants of mothers with vitamin D deficiency: Hypercalcemia: Malignancy: Drugs Thiazide diuretics Vitamin D intoxication Lithium: . Can Low Vitamin D Cause Neuropathy? | OmegaQuant The dose needed for maintenance may be lower than that needed to treat the deficiency. Seizures caused by pyridoxine (vitamin B6) deficiency in adults: A case Can a Lack of Vitamin D Cause Numbness in the Extremities? Have little exposure to sunlight, because you: Have darker skin, for example if you are of African, African-Caribbean or South Asian origin (because your body is not able to make as much vitamin D from sunlight). Here, we measured serum 25-hydroxy-vitamin D (25(OH)D) levels and normalized it by administration of vitamin D3 in 13 patients with pharmacoresistant epilepsy. Still, hypophosphatemia was not well reported because, in 39.8% of cases, the phosphorus level was never tested [6]. In some countries (but not in the UK) all milk is fortified with vitamin D. Many people have no vitamin D deficiency symptoms or may complain of only vague ones such as tiredness or general aches. Would you like email updates of new search results? and transmitted securely. Vitamin D bolus was given along with calcium correction, following which she improved. Accessibility Nutritional rickets: This is usually caused by not taking in enough vitamin D, which your body uses to absorb calcium. Kossoff EH, Silvia MT, Maret A, Carakushansky M, Vining EP. However,their incubation periods have also decreased. Incidences of neurological symptoms such as headaches, dizziness, encephalitis, and seizures have also been described [1,2]. Vitals were normal and physical examination this time was only significant for resultant postictal confusion. D. level, the others were low or deficient. Some people complain of a general tiredness, vague aches and pains and a general sense of not being well. doi: 10.1002/14651858.CD000227.pub4. Epub 2020 Nov 10. Helping to stave off depression and low mood. A study published in 2012 showed that correcting vitamin D deficiency reduced seizures in people with epilepsy. In a large cardiovascular health study of 2,300 people, sudden cardiac death was twice as high (2 vs. 4 deaths in 1,000 people) for those with vitaminD levels below 20 ng/dl compared to individuals with levels above 20 ng/dl.2 One possible cause of SUDEP is irregular heart rhythm. The diagnosis of hypocalcemic seizures as a result of vitamin D deficiency was confirmed by measurement of serum 25-hydroxyvitamin D [25-OH-D] (7.9 ng/mL, normal: 20 ng/mL) and 1,25-dihydroxyvitamin D [1,25-OH2-D] (7.2 pg/mL, normal: 20-60 pg/mL). Tingling lips. Vitamin D toxicity: What if you get too much? - Mayo Clinic A metabolic panel obtained upon ED arrival again demonstrated hypophosphatemia of 1.9 mg/dL (normal range: 2.6-4.5 mg/dL) (Table (Table2).2). Muscle spasms (tetany) may be the first sign of rickets in infants. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. SARS-CoV-2 causes coronavirus disease 2019 (COVID-19). There are different strengths available and a dose may be taken either daily, weekly or monthly. Epilepsy News From: Tuesday, October 10, 2017. A Keppra level obtained was also found to be borderline therapeutic, indicating compliance with therapy. Epilepsy and COVID-19: updated evidence and narrative review. Hypophosphatemia compared to classical biomarkers of tonic clonic seizures. Seizures. Our patient hadserum vitamin D2 and D3 levelsdrawn on the date of the first presentation. Unable to load your collection due to an error, Unable to load your delegates due to an error. Keywords: Vitamin B6 deficiency, Seizure Go to: Introduction Vitamin B6 is part of the vitamin B group complex and can serve as a cofactor in the metabolism of glucose, amino acids, and lipids. Sunlight is the prime source of vitamin D. However, in our current lifestyle, exposure to sunlight is less and food alone might not be sufficient, thereby leading to hypocalcemia. She has never been put on an AED as they have thought her seizures to be metebolic or endocrine related. Since vitamin D2/D3 levels weresend-out tests, their results had not returned at the time of discharge. Electrocardiogram showing mild ST segment depression in anterolateral leads with T wave inversion in V1-4, T wave flattening in V5-6 with QT prolonged. The complications of severe deficiency have been mentioned. official website and that any information you provide is encrypted Hypocalcemic Seizure Due to Vitamin D Deficiency - PMC Imaging studies, which included a CT scanof the head (Video (Video1)1) andthe cervical spine (Video (Video2)2) and a radiograph of the chest (Figure (Figure2),2), were all within normal limits. All rights reserved. Kumar R, Rathi H, Haq A, Wimalawansa SJ, Sharma A. The National Institute of Health recommends daily calcium intake of 1,0001,200 mg in adults. Careers, Unable to load your collection due to an error. Vitamin D is required for the intestinal absorption of calcium. "Johns Hopkins' researcher JM Freeman (M.D.) Vitamin D deficiency in homebound elderly persons. from the best health experts in the business, Osteoporosis: assessing the risk of fragility fracture; NICE Clinical Guideline (August 2012, updated February 2017), Management of osteoporosis and the prevention of fragility fractures - A national clinical guideline; Scottish Intercollegiate Guidelines Network (SIGN - January 2021), Clinical guideline for the prevention and treatment of osteoporosis; National Osteoporosis Guideline Group (NOGG - 2017), Hip fracture: management; NICE Guideline (June 2011, updated January 2023), Vitamin D and health; Scientific Advisory Committee on Nutrition (July 2016), Sunlight exposure: risks and benefits; NICE Guidance (February 2016). Therefore, supplementation of phosphate and vitamin D should be considered in deficient patients at risk for severe COVID-19 disease outcomes [10]. For details see our conditions. She never had any seizures until she started a stupid "cleansing" diet. Bookshelf Acute Symptomatic Seizures Caused by Electrolyte Disturbances Malieckal et al.