Elsevier

Epilepsy & Behavior

Volume 52, Part A, November 2015, Pages 154-158
Epilepsy & Behavior

Pyridoxine deficiency in adult patients with status epilepticus

https://doi.org/10.1016/j.yebeh.2015.08.015Get rights and content

Highlights

  • Pyridoxine deficiency has been primarily reported in infant and childhood seizures.

  • Low or undetectable levels of pyridoxine occurred in 94% of patient in RSE and SRSE.

  • Replacement therapy did not result in immediate resolution of SE.

  • Pyridoxine deficiency may increase glutamate resulting in enhanced excitation.

Abstract

An 8-year-old girl treated at our facility for superrefractory status epilepticus was found to have a low pyridoxine level at 5 μg/L. After starting pyridoxine supplementation, improvement in the EEG for a 24-hour period was seen. We decided to look at the pyridoxine levels in adult patients admitted with status epilepticus. We reviewed the records on patients admitted to the neurological ICU for status epilepticus (SE). Eighty-one adult patients were identified with documented pyridoxine levels. For comparison purposes, we looked at pyridoxine levels in outpatients with epilepsy (n = 132). Reported normal pyridoxine range is > 10 ng/mL. All but six patients admitted for SE had low normal or undetectable pyridoxine levels. A selective pyridoxine deficiency was seen in 94% of patients with status epilepticus (compared to 39.4% in the outpatients) which leads us to believe that there is a relationship between status epilepticus and pyridoxine levels.

Introduction

An 8-year-old girl admitted for status epilepticus had seizures refractory to multiple AED's, VNS placement, ketamine infusion, and propofol infusion. She had a low pyridoxine level of 5 ng/mL. An improvement in the EEG was seen within 24 h after starting pyridoxine supplementation. The patient died of complications secondary to hypothermia protocol and metabolic acidosis. In light of her short but impressive response to pyridoxine, we decided to look at pyridoxine levels in our adult patients with status epilepticus (SE).

Section snippets

Methods

We obtained IRB approval to evaluate our patients admitted to the Ochsner Medical Center, Jefferson Campus, neurological ICU for SE. The patients were admitted between January 2014 and February 2015. Eighty-one adult patients with SE were identified with documented pyridoxine levels. For comparison purposes, we looked at serum pyridoxine levels in outpatients with epilepsy from the past three years (n = 132). A level of 10 ng/mL and below was chosen as a low pyridoxine level.

Results

Upon review of the data, all but six of the patients admitted for SE had low levels of pyridoxine of which seventeen patients had undetectable levels. When this was compared to the outpatient population, a larger proportion of patients (n = 80) had normal levels of pyridoxine. None of the patients in the outpatient group had undetectable levels. The mean pyridoxine was 4.7 ng/ml in the group with status epilepticus and 25.2 ng/ml in the outpatient group. This difference is statistically significant

Pyridoxine

Albert Svent-Gyorgy first isolated pyridoxine in 1934 [1]. Pyridoxine is found in animal and plant-derived food [2]. The standard vitamin B6 supplement is pyridoxine hydrochloride (HCL) which is inexpensive. Pyridoxine is a water soluble vitamin and is absorbed by the upper small intestine. It is then transported to the liver where it is first oxidized to pyridoxal and then undergoes phosphorylation to pyridoxal 5′-phosphate (P5P) in the liver. The metabolic active coenzyme form of vitamin B6

Conclusion

A selective pyridoxine deficiency was seen in 94% of patients with status epilepticus (compared to 39% in the outpatients) which leads us to believe that there is a relationship between status epilepticus and pyridoxine levels. The difference in mean pyridoxine level in the group with status epilepticus was statistically significant to the comparison group. Further studies on the effect of pyridoxine on status epilepticus control are needed.

Conflicts of interest

None.

References (11)

  • J. Leklem

    Vitamin B6: a status report

    J Nutr

    (1990)
  • Vitamin B6 (pyridoxine; pyridoxal 5′-phosphate) monograph

    Altern Med Rev

    (2001)
  • Y. Tong

    Seizures caused by pyridoxine deficiency in adults: a case report and literature review

    Intractable Rare Dis Res

    (2014)
  • N. Awad

    Pyridoxine for refractory status epilepticus: “Fly like a G6”. Weblog entry. Emergency Medicine

  • L. Valle-Morales et al.

    Epileptic status refractory to conventional treatment caused by vitamin B6 deficiency

    J Perinatol

    (2009)
There are more references available in the full text version of this article.

Cited by (10)

  • Engineering ZnO nanocrystals anchored on mesoporous TiO<inf>2</inf> for simultaneous detection of vitamins

    2022, Biochemical Engineering Journal
    Citation Excerpt :

    On the other hand, if we do not consume vitamin (B2, B6 and C) containing foods our body can face difficulties in adsorbing or processing the essential nutrients. As reported by the dietary allowance consuming less than the recommended levels of vitamin C (26.52 µM), vitamin B6 (1.3 mg) and vitamin B2 (40 µg) per day can cause deficiency [4–6]. Vitamin deficiency can arise with irregular generation of red blood cells and thereby reduces the carrier oxygen to blood, and also shows various symptoms such as dizziness, weariness, and shortness of breath [7–9].

  • Levetiracetam-associated irritability and potential role of vitamin B6 use in veterans with epilepsy

    2021, Epilepsy and Behavior Reports
    Citation Excerpt :

    Pyridoxine depletion or deficiency has been shown to decrease glutamic acid decarboxylase, glutamic acid, and 5-hydroxytryptophan (5-HT) concentrations in rodent models [10,11]. In humans, vitamin B6 deficiency (typical reference range for PLP is 5–50 ug/ml) can lead to anemia, depression, confusion, and immunosuppression, has been linked to irritability and seizures in infants [12], and implicated in status epilepticus [13]. In addition to the treatment of levetiracetam-associated irritability, supplementation of vitamin B6 has been studied in reducing the prevalence of tardive dyskinesia in patients with schizophrenia [14], reducing premenstrual syndrome symptoms including irritability, moodiness, and anxiety [12,15], as well as potentially leading to improvement of depression symptoms in elderly patients [12,16].

  • Increased leptin-b expression and metalloprotease expression contributed to the pyridoxine-associated toxicity in zebrafish larvae displaying seizure-like behavior

    2020, Biochemical Pharmacology
    Citation Excerpt :

    Currently, epilepsy has been attributed to genetic, physical and metabolic causes [3–6]. Studies showed that epileptic encephalopathy can be induced by certain metabolic disorders and nutritional defects, including vitamins deficiency [7–11]. Therefore, diet control, especially vitamins supplementation, is often recommended to assist the treatment for epilepsy [12,13].

  • The B-vitamins

    2020, Essential and Toxic Trace Elements and Vitamins in Human Health
View all citing articles on Scopus
View full text