Whether Ramadan fasting influences seizure occurrence is an important clinical question for patients with epilepsy. Limited prior studies on this topic have yielded conflicting results.

We conducted a retrospective observational study of all seizure-related emergency department (ED) visits in Hamad Medical Corporation hospitals (Qatar) during Ramadan and the adjacent month before and after, over 2021–2023. Patient data (demographics, seizure features, outcomes, and management) were collected. We compared Ramadan versus non-Ramadan periods, including subgroup analyses for first-time seizures and known epileptic patients. Additionally, an age- and sex-matched case–control analysis (n=142) was performed, matching fasting Ramadan cases to non-Ramadan controls.

Among 1,492 seizure-related ED visits (470 during Ramadan; 1,022 in combined non-Ramadan months), the proportion of total ED visits due to seizures was similar during (0.80%) and outside Ramadan (0.81%). No significant differences were found in clinical severity markers (rates of status epilepticus, seizure clustering, hospital admissions, or 72-hour revisits) between Ramadan and non-Ramadan periods (all p>0.05). First-time seizure presentations and known epilepsy cases showed no worsening of seizure severity or provocation during Ramadan. In the matched case–control subset, fasting patients were more likely to receive intravenous antiseizure medication loading in the ED (40.0% vs 18.3%, p=0.005) and less likely to be started on new antiseizure medication (5.7% vs 20.4%, p=0.026). Fasting epileptic patients also had significantly higher rates of prior good seizure control (69.8% vs 32.7%, p<0.001).

Ramadan fasting was not associated with an increase in seizure frequency in this ED-based study. Patients with well-controlled epilepsy tolerated fasting without incident, while physicians adjusted acute management strategies during fasting. These findings support the safety of Ramadan fasting in patients with stable epilepsy. Future prospective studies should confirm these results and address the post-Ramadan increase in seizures and changes in management practices.