A seizure is a sudden, uncontrolled electrical disturbance in the brain that causes changes in behavior, movement, feelings, or consciousness. While the seizure itself does not directly cause hair loss (alopecia), a link exists through indirect pathways. Hair thinning is a known side effect for some people managing this neurological condition, primarily due to long-term anti-seizure medication and the physiological stress of frequent seizures.
Medication Side Effects and Hair Loss
The most common cause of hair loss in people with epilepsy is the use of Anti-Seizure Medications (ASMs). Certain ASMs can disrupt the normal hair growth cycle, which consists of three main phases: anagen (growth), catagen (transition), and telogen (resting/shedding).
The hair loss seen with ASMs is overwhelmingly Telogen Effluvium, where a chemical change pushes hair follicles prematurely into the telogen phase. This results in diffuse, non-scarring hair thinning across the scalp, often noticeable three to six months after starting a new medication. The most frequently implicated medications include valproate (VPA), carbamazepine, and lamotrigine. VPA has a reported incidence of hair loss in up to 24% of users in some studies.
The precise mechanisms for this drug-induced alopecia vary between ASMs, but many involve interference with the metabolic processes of the hair follicle. Valproate, for instance, is thought to interfere with the absorption and metabolism of certain micronutrients that are necessary for healthy hair growth. This includes the depletion of biotin and the interference with folate metabolism, both of which are cofactors for enzymes involved in cell division and growth.
The hair loss associated with valproate can also be dose-dependent, meaning a higher concentration of the drug in the bloodstream may correlate with a greater chance of experiencing hair thinning. Studies indicate that high VPA blood levels, sometimes in the range of 80 to 150 mcg/L, are associated with a greater incidence of alopecia compared to therapeutic levels between 25 and 50 mcg/L. Other ASMs, such as levetiracetam and topiramate, also have rare reports of causing hair loss, though their incidence is much lower than that of VPA. A characteristic feature of this drug-induced hair loss is its reversibility, with hair growth often resuming after the medication dose is adjusted or the drug is discontinued.
Stress Responses and Associated Conditions
Beyond medication effects, the profound physiological and psychological stress associated with chronic epilepsy can independently trigger hair loss. Severe or frequent seizures, or the ongoing anxiety of living with the condition, act as significant stressors. This intense stress can interrupt the hair growth cycle and precipitate temporary shedding.
The stressful event causes a shock to the hair follicles, prematurely shifting them into the resting phase. Because hair follicles stay in the resting phase for approximately three months before shedding, the hair loss typically appears delayed from the initial stressor. The thinning is generally diffuse and temporary, with regrowth expected once the underlying stress is managed.
In very rare instances, hair loss and seizures can be symptoms of a single, underlying systemic issue, often a genetic syndrome. Conditions like Alopecia-epilepsy-pyorrhea-intellectual disability syndrome, sometimes referred to as Shokeir syndrome, present with both congenital permanent alopecia and psychomotor epilepsy. Another example is Moynahan syndrome, which is characterized by congenital alopecia, early-onset epilepsy, and intellectual disability.
Strategies for Addressing Hair Thinning
If hair thinning is observed, the first and most important step is to consult with the treating physician, typically the neurologist who manages the epilepsy. It is imperative not to abruptly stop or change any ASM, as this could lead to breakthrough seizures or status epilepticus, which is a medical emergency. The physician will assess the pattern of hair loss and may order blood tests to check for nutritional deficiencies or underlying medical conditions.
One of the most effective strategies involves adjusting the current medication regimen. This may include lowering the dose of the implicated ASM or switching to an alternative drug that has a lower known risk of causing alopecia, such as levetiracetam or oxcarbazepine. Since the hair loss is often reversible, a change in therapy can stop the shedding and allow for eventual hair regrowth.
Nutritional interventions can also be beneficial, particularly when a medication like valproate is suspected of causing nutrient depletion. Supplementation with specific micronutrients, such as biotin and folic acid (folate), may be suggested by the healthcare provider to counteract the drug’s metabolic interference. Some research also suggests that supplementation with minerals like zinc and selenium could help promote regrowth in cases of ASM-induced alopecia. Any change to the diet or the addition of supplements must be discussed with the physician first to ensure they do not interact negatively with the prescribed anti-seizure medication.