Can vaccines cause seizures?

Vaccination recommendation for people with epilepsy against Covid-19

Vaccination recommendations of the DGfE

by Thomas Mayer, Günter Krämer and Ulrich Brandl

In principle, the same vaccination recommendations apply to people with epilepsy as to all other people. In Germany, the so-called "Standing Vaccination Commission (STIKO)" based at the Robert Koch Institute defines the recommendations and updates them regularly (1). In individual federal states such as E.g. in Saxony there are additional local vaccination commissions, but they are not always up to date (the STIKO report Saxony of 02/02/2021 does not mention the coronavirus vaccination at all).

Vaccinations are usually carried out for two reasons: Either they are intended to prevent accumulations (epidemics) of serious illnesses for which there is no therapy, or they are intended to protect individual people from serious illnesses that are difficult to treat or cannot be treated occur epidemically. The first group includes e.g. smallpox, measles or polio (poliomyelitis), currently also the Covid-19 disease, which can be transmitted by SARS-CoV-2 coronaviruses). In the second group these are e.g. diphtheria, Haemophilus influenza type B (HIB), hepatitis (A and B), pertussis (whooping cough), pneumococci or tetanus (tetanus). In addition, vaccinations against influenza (flu), early summer meningoencephalitis (TBE), yellow fever, rabies as well as typhoid and paratyphoid are available for certain groups of people and when traveling to certain areas. Vaccinations are targeted stimulation of the body's defense functions against pathogens. The measles vaccination is now part of a recruitment requirement in most social professions in Germany and has led to measles, with 75 reported cases, being almost eradicated in 2020 (2).

Traditional vaccines consist of killed or living bacteria or viruses or parts thereof, to whose administration the body reacts with the formation of defense cells and defense substances (antibodies). Some of the new Covid-19 vaccines are called mRNA vaccines. mRNA is the “building instruction” for every single protein in the body and should not be confused with human genetic information - DNA. The mRNA vaccine against COVID-19 contains “building instructions” for a single component of the virus (a so-called spike protein). This spike protein is harmless on its own and the vaccine is therefore not infectious. The mRNA contained in the vaccine is not incorporated into the human genome, but rather broken down in the body after a few days. Vaccinations give immunity to subsequent contact with the relevant pathogens (3). This can last for a lifetime, but some pathogens require booster vaccinations from time to time.

Because vaccines have been improved over the last few decades, complications are becoming less and less common. Serious complications with permanent damage are possible in very rare cases, but the risk is orders of magnitude lower than the risk of the particular disease against which the vaccine is being vaccinated. This basic risk is not related to epilepsy (4).

The frequently cited “vaccine damage” in children in connection with epilepsy can almost all be assigned to Dravet syndrome (5). This is a genetic disease with a severe course of epilepsy and a considerable impairment of mental development. In this condition, the first epileptic seizure usually occurs when a child goes through the first fever. Often this is caused by the first vaccinations. The vaccination thus often determines the time of the first visible symptom, but it is not the cause of the disease itself. The disease is just as severe in non-vaccinated children as it is in vaccinated children (6). Even children with known Dravet syndrome can and should be immunized with the vaccinations recommended by STIKO. They have a fever prophylaxis through one
concurrent or previous administration of medication such as paracetamol to reduce the risk of long-term seizures.

The vast majority of children, adolescents and adults with active epilepsy can be vaccinated without any problems, without having to expect an increased rate of serious side effects. An exception is treatment with ACTH or corticosteroids; there should be an interval of at least three months between treatment and vaccination.

Almost all seizures reported in children after vaccination are caused by fever. Fever is a side effect that can appear briefly with many vaccines. With some vaccines, fever occurs sooner after administration, with live vaccines such as measles, mumps or rubella it can take 5-10 days to develop.

In children with known fever-related epileptic seizures ("febrile convulsions") as an isolated symptom or in the context of an existing epilepsy, vaccinations, which are often associated with a general febrile reaction, may be given antipyretic drugs (paracetamol, ibuprofen) as a precautionary measure and, if necessary, a drug to stop them longer lasting seizures are kept ready (7). In younger children (<2 years of age) it has been observed that the measles, mumps and rubella vaccination in combination with the chickenpox vaccine leads to fever-induced seizures more frequently than separate administration of the vaccines. This should be taken into account if the child in question is known to have a tendency to fever-induced seizures (10).

The influenza vaccination can also trigger febrile seizures. A Norwegian study (7) was able to show that the likelihood of triggering fever-induced attacks by the flu vaccination is much lower than with flu. It has also been observed that the simultaneous use of flu and pneumococcal vaccines triggers febrile seizures slightly more frequently than the separate use of these vaccines (9).

No study showed evidence that the vaccines mentioned could cause epilepsy; it is always about the triggering of individual fever-related seizures.

For adult epilepsy patients, the vaccinations recommended for this age group (pneumococci, flu, refreshments from other vaccinations) can be regarded as unproblematic. The willingness to have fever-induced seizures slowly decreases in most children with increasing age; in adults these are extremely rare. In the case of patients who otherwise have increased seizures due to fevers and infections, the use of antipyretic drugs after the vaccination can also be considered here.

Regarding the vaccination against SARS-CoV-2 coronaviruses with RNA vaccines (Comirnaty® from BioNtec-Pfizer) and Covid-19 Vaccine (Moderna® from Moderna), which is currently approved in Germany, there are both from the study data and from a preliminary analysis of Side effects no evidence that this can trigger seizures. Here, too, it should be noted that some patients may react with a fever and therefore, if they have a history of fever-induced seizures, antipyretic drugs should be administered if necessary (4).

The recommendation to vaccinate particularly pregnant women and people with chronic illnesses should also apply to women with epilepsy and especially older people with epilepsy and chronic illness. All other specific recommendations, especially for new vaccines, should be based on the recommendations of the STIKO (1).

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  1. http://www.rki.de/DE/Content/Kommissions/STIKO/stiko_node.html (access: 19.01.2021)
  2. https://www.masernschutz.de/themen/masern-imörderung.html (access: 19.01.2021)
  3. https://www.rki.de/DE/Content/Infekt/Impfen/Materialien/Downloads-COVID-19/Aufklaerungsbogen-de.pdf?__blob=publicationFile (access: 19.01.2021)
  4. Krämer G. Vaccinations and malaria prophylaxis for epilepsy www.swissepi.ch
  5. Berkovic SF, Harkin L, McMahon JM et al .: De-novo mutations of the sodium channel gene SCN1A in alleged vaccine encephalopathy: a retrospective study. Lancet Neurol 2006: 5: 488-92.
  6. McIntosh AM, McMahon J, Dibbens LM et al: Effects of vaccination on onset and outcome of Dravet syndrome: a retrospective study, Lancet Neurology 2010; 9: 592-8.
  7. von Spiczak S, Helbig I, Drechsel-Baeuerle U et al: A retrospective population-based study on seizures related to childhood vaccination. Epilepsia 2011; 52): 1506-12.
  8. Bakken IJ, Aaberg KM, Ghaderi S et al. Febrile seizures after 2009 influenza A (H1N1) vaccination and infection: a nationwide registry-based study. BMC Infect Dis 2015; 15:506.
  9. Tse A, Tseng HF, Greene S et al .: Signal identification and evaluation for risk of febrile seizures in children following trivalent inactivated influenza vaccine in the Vaccine Safety Datalink Project. Vaccine 2012; 30: 2024-31
  10. Schink T, Holstiege J, Kowalzik F et al .: Risk of febrile convulsions after MMRV vaccination in comparison to MMR or MMR + V vaccination. Vaccine 2014: 32: 645-50