SJLA_2024_A5: Seizure Risk, Contributing Factors and Management Post Bariatric Surgery: Systematic
Authors: Alyahya Mohammed , Alshablan Reham , Aldossary Maiyada , Bojbara Loay , Aldhubaib Abdulaziz , Foula Mohammed , Alarfaj Mosab , Alratrout Hefzi 
Published: September 2024

Introduction:
The prevalence of bariatric surgery as a treatment for obesity has brought to light its implications for various health outcomes, including neurological disorders such as seizures and epilepsy. Obesity itself has been linked to neurological health, raising questions about the impact of its treatments, such as bariatric surgery, on neurological outcomes.

Background:
A study in this domain was conducted; their research investigated the risk of epilepsy following bariatric surgery in comparison to a nonsurgical cohort with an obesity diagnosis. Their results indicated a higher incidence of epilepsy in the postbariatric surgery group. These findings underscore the necessity of this systematic review. The relationship between bariatric surgery and neurological outcomes such as epilepsy remains inadequately explored, with potential long-term risks that warrant further investigation. Therefore, this review aims to synthesize available evidence, evaluate the effects of bariatric surgery on epilepsy risk, and identify potential mechanisms and risk factors.

Methods:
This review includes eligible case reports and cohort studies on people who developed postbariatric seizure between September 1962 and January 2024, selected from three primary databases: PubMed (NCBI), Embase (OvidSP), and Web of Science. The selection process was based on three phases: title, abstract, and full-text screening, and we included 19 articles.

Results:
Among the case reports, 14 out of 15 are associated with Roux-en-Y gastric bypass (RYGB) surgery. The causes of postbariatric seizures were diverse, with 56% attributed to hypoglycemia, 19% to hyperammonemia, and the remaining cases linked to hypocalcemia, vitamin deficiency, and postbariatric stroke. Cohort studies assessing postbariatric seizure risk showed significant findings. One study reported HR of 1.45, and another found HRs of 3 and 7.3 for epilepsy and seizures, respectively. These findings underline increased risk after bariatric surgeries. Management varies widely, including surgical and medical treatment. Surgical treatment by RYGB reversal was reported in several cases, with two approaches, including laparoscopic restoration using a Henley-Longmire interposition and distal pancreatectomy. Medical management involved antiepileptic drugs, antihypoglycemic agents, and specific therapy for hyperammonemia and hypocalcemia.

Discussion:
The results of this review suggest a link between bariatric surgeries and developing seizures. However, the majority of the studies concluded hypoglycemia was primarily associated with these outcomes. Few studies suggest hyperammonemia as a contributing factor; two studies implicate urea cycle disorders. Furthermore, surgical management showed the most effective way to control postbariatric hypoglycemia alongside other specific treatments for certain conditions, such as hyperammonemia. The main limitation of our review is the need for primary studies.

Conclusion:
Findings from this review highlight the need for continuous monitoring postoperatively to address any risks of seizures following bariatric surgery, as early detection of seizures can prevent adverse outcomes. Moreover, healthcare providers should focus on patients’ education regarding the risk of seizures, enabling them to recognize symptoms and seek medical care. Furthermore, these findings highlight the importance of continuous follow-up to optimize patient safety and improve long-term outcomes for individuals undergoing bariatric surgery.