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Epilepsy

epilepsy and gastic bypass surgery

09/10/2010

Question:

my son is 345 lbs. at 30 yrs old with high BP, sleep apnea and wetting himself now at night. He has not had a seizure in over 10 years. On Keppra most of that time but now on Vimpat due to all side effects and wt. gain of Keppra. He wants gastric bypass. I am wondering about seizures starting up again afterwards due to the malabsorbtion of fat since fat seems to stop seizures in some people who eat a ketogenic diet or it affecting absorbtion of his anticonvulsant meds. I have seen some blogs about it but no real reputable literature on it. can you help?

Answer:

I would not be concerned about fat absorption affecting seizure control. The ketogenic diet works more because of lack of carbohydrates triggering metabolism of fat, rather than the fat in the diet itself being therapeutic. No one knows truly why the ketogenic diet works, but that's the best current understanding. The more important issue is adequate absorption of antiepileptic drugs, especially with slow release formulations. I would not recommend using any extended release formulations of seizure medications. Some, like Tegretol XR rely on slow release of the medication through the small and large bowel, so if that transit time is faster, as sometimes happens after surgery, less medication might be delivered. Also, it will be important to check blood levels of seizure medications before and intermittently after the surgery no matter what formulation he is on. As long as the levels are comparable, that can help verify that the absorption of the medications has not been affected.

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Response by:

Michael   Privitera, MD Michael Privitera, MD
Professor of Neurology
College of Medicine
University of Cincinnati