Seizures as a Neurological Sequela of Roux-en-Y Gastric Bypass Surgery: A Systematic Review
Dorene Blum1, Sydney Hopkins1, Woo Sik Kim1, Haley Miller1
1Des Moines University College of Osteopathic Medicine
Objective:
To synthesize the existing literature on the causes, types, and management of postoperative seizures following Roux-en-Y gastric bypass surgery.
Background:
Seizures represent an uncommon yet clinically significant complication of Roux-en-Y gastric bypass surgery (RYGB). Postoperative metabolic disturbances, such as hypoglycemia and nutrient deficiencies, may be likely contributors. However, their exact causes and management appear scattered in literature.
Design/Methods:
A systematic review of 16 articles indexed in PubMed between 2000 and 2025 was performed following PRISMA guidelines. This included ten case reports, three literature reviews, two cohort studies, and one cross-sectional study involving 82 cases of postoperative seizures following RYGB. The data were extracted and categorized by study type, seizure type, cause of seizure, and management.
Results:
The leading cause of postoperative seizures in ten studies was hypoglycemia (77 cases) and included postprandial and nocturnal hypoglycemia. Nutrient deficiencies such as thiamine and pyridoxine accounted for four cases. One case was due to inadequate dosing of seizure medication due to changes in absorption following RYGB. The most reported mechanism of resolution for seizures due to hypoglycemia was through surgical interventions such as pancreatectomy (eight cases). Seizures due to nutrient deficiencies were resolved through nutrient administration (four cases), and the seizure due to inadequate medication dosing was resolved through medication management. Generalized tonic-clonic seizures were noted in four cases and status epilepticus was noted in one case; however, 11 studies did not specify the type of seizure.
Conclusions:
Hypoglycemia was the predominant cause of postoperative seizures following RYGB and may warrant close observation and patient education. Other causes included nutrient deficiencies and changes in seizure medication absorption, highlighting the importance of patient adherence and monitoring nutrient and medication levels following RYGB. Understanding the common causes and management of postoperative seizures following RYGB can guide evidence-based clinical approaches in neurologic care.
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