New Feature on Living Well With Epilepsy
Living Well With Epilepsy has partnered with the International League Against Epilepsy (ILAE) to bring you a series on Hot Neurobiology Topics in Epilepsy. This initiative is led by the ILAE Neurobiology Commission (NBC), which is chaired by Aristea Galanopoulou, MD, PhD (USA). Dr. Galanopoulou, Professor of Neurology and Professor of Neuroscience, Albert Einstein College of Medicine, works towards promoting neurobiology research in epilepsy through advocacy, education, training, proposals of optimal methodologies and infrastructure improvements. The NBC organizes activities aimed at informing the progress and best practices in neurobiology of epilepsy research, including symposia, workshops and reports.
Thank you to the commission members for spearheading this initiative. We hope you enjoy this series.
Kathryn A. Davis, MD, MSTR, Assistant Professor of Neurology at the University of Pennsylvania and member of the ILAE NBC recently had the opportunity to connect with Astrid Nehlig, PhD, a research director at the French Medical Research Institute, INSERM in Strasbourg. Dr. Davis has shared her interview with Dr. Nehlig where they discuss the topic of Caffeine and Epilepsy.
Dr. Nehlig’s main research interests are brain metabolism, brain development, absence and temporal lobe epilepsy, and the effects of coffee and caffeine on health, mainly on brain function. Dr. Nehlig has published her research extensively, given invited lectures worldwide and is on the editorial board of multiple prominent epilepsy journals.
Caffeine and Epilepsy
Astrid Nehlig, PhD: The number of available studies on the effects of caffeine on seizures is scarce. Mostly two clinical studies, one performed in a hospital on 174 patients and a large questionnaire study including 105,941 nurses did not report any difference in seizure control and occurrence between days with or with no caffeine (in the second study, the mean daily caffeine intake was 437 mg, i.e. about 3-4 cups of coffee).
Likewise, in a cohort of 35,596 children no association was reported between the antenatal use of caffeine by pregnant women and the risk of occurrence of febrile seizures in the first 3 months of life. Similarly, in premature babies with apnea, the treatment with caffeine citrate (30 mg/kg) does not impact seizure occurrence and the risk of epilepsy.
NBC: Do coffee or drinks with caffeine have the same effects on different types of seizures?
AN: As mentioned in the previous answer, caffeine intake does not seem to impact seizure occurrence whatever the type of seizures.
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NBC: Does everyone react the same way to coffee or drinks with caffeine?
AN: The answer here is no. There are some case reports mentioning the occurrence of seizures and even status epilepticus after the ingestion of caffeine. This rather occurs after the ingestion of high to very high daily doses of caffeine, most often in the range of 500-1000 mg/day. As a memo a cup of coffee contains about 100-150 mg caffeine (125 ml), a cup of tea 40-60 mg (125 ml), a cola drink 40 mg (33 ml), and a can of energy drink 80-160 mg according to the size (250-500 ml).
In fact it seems like the threshold for seizures is an individual factor that may vary and people with epilepsy can quite easily notice at which dose and in which conditions a potential increase in seizure occurrence starts and they should be advised to maintain their daily intake below this dose.
NBC: Should people with seizures be drinking caffeinated beverages or should they avoid it and when?
AN: From the available data, it does not appear that people with epilepsy should avoid drinking caffeinated drinks as long as they do not go over their individual limit. They could be advised to avoid drinking a large quantity of caffeinated drinks in a short amount of time, especially on an empty stomach while a reasonable timed caffeine intake does not seem to impact seizure occurrence. In animal studies, it has even be reported that the chronic exposure to caffeine is protective, reduces the occurrence of seizures and has no deleterious consequences as reported for an acute intake.
NBC: Does caffeine change the effects of seizure medications?
AN: The number of studies on this point is very limited, especially in humans. It was reported that in healthy volunteers that the tissue half-like of carbamazepine is doubled in the presence of 300 mg of caffeine while its bioavailability is reduced by 32%. Phenytoin and phenobarbital seem to alter caffeine metabolism as well. More studies are needed on this point.
NBC: Do pregnant women have to be more careful about drinking coffee or drinks with caffeine?
AN: Pregnant mothers should remain in the advised daily limit of 200 mg caffeine intake at which no report of increased risk of seizures has been observed in humans. A slight increased risk has been reported in animal studies but to the best of the present knowledge and based on the study cited above concerning the cohort of Danish pregnant women, caffeine consumption in reasonable amounts does not seem to impact the seizure risk in children.
NBC: What are the unanswered questions regarding caffeine and epilepsy?
AN: At this point, we have only a limited knowledge on the interaction between various seizure medications and caffeine. It may well be that the reports of single cases with seizures might be due to the interaction between caffeine and the medication as much as individual sensitivity.
We also need to explore the genetic bases of caffeine metabolism, actions on the body and brain to better understand the inter-individual differences in the sensitivity to caffeine, especially in people with epilepsy.
Thank you to Drs. Nehlig and Davis for this informative interview on caffeine and epilepsy. We look forward to future Hot Neurobiology Topics in Epilepsy.