People with neurological conditions such as epilepsy, migraine, Parkinson’s disease and multiple sclerosis should consult their physicians and undergo detailed evaluations before deciding to fast during Ramadan, a Turkish neurologist said.
Professor Şeref Demirkaya, a faculty member in the Department of Neurology at University of Health Sciences – Gulhane Faculty of Medicine, told Anadolu Agency (AA) that patients frequently ask whether they can fast during the holy month.
“With the arrival of Ramadan, the most common question we receive in neurology outpatient clinics is, ‘Can I fast?’” Demirkaya said, noting a surge in consultations during this period.
He emphasized that there is no single “yes” or “no” answer. Decisions should be made based on the patient’s overall health, type and severity of disease, medications and risk factors.
“We evaluate whether a patient can fast by considering their general health status, the type of illness, medications used and risk factors,” he said. “On one hand, we want our patients to fulfill their religious duties with peace of mind; on the other, we aim to ensure their health is not compromised.”
Ramadan should not be viewed solely as prolonged hunger, Demirkaya said. Reduced fluid intake can lead to electrolyte imbalances and changes in sleep patterns may trigger certain neurological conditions.
He added that altered eating habits and compressing medication schedules between pre-dawn (sahur) and sunset (iftar) meals can pose challenges, particularly for patients taking multiple medications.
“Patients should speak with the physician who follows their condition before fasting,” Demirkaya said. “Their own doctor knows their disease best and can determine whether medications can be taken between morning and evening and whether their diet is appropriate.”
Hunger is one of the triggers for epilepsy, Demirkaya said. Prolonged dehydration-related electrolyte disturbances and sleep deprivation can also provoke seizures.
Some epilepsy patients require multiple medications at different times of the day - a regimen known as polytherapy - which can be difficult to adjust to two daily doses during Ramadan. Decisions should be made after evaluating seizure frequency and severity, as well as the medications used, he said.
Migraine patients may experience an increase in headaches during the first days of Ramadan due to prolonged hunger and lack of sleep, Demirkaya said.
Like epilepsy, migraine can be triggered by fasting and sleep deprivation. Changes in dietary habits may also exacerbate symptoms.
He advised migraine patients not to skip the pre-dawn meal, to maintain a balanced diet and to ensure adequate sleep throughout Ramadan. Maintaining stable blood sugar levels is also important, he said.
The decision to fast should also be made in consultation with a physician for patients with Parkinson’s disease, Demirkaya said, noting that most patients are over 65.
One of the main symptoms of Parkinson’s is limited mobility. To maintain daily functioning, patients receive medication in divided doses throughout the day to replace a deficient substance in the brain.
Interruptions in medication schedules can worsen movement limitations, making strict adherence to dosing times critical, he said.
The course, type and severity of multiple sclerosis vary from patient to patient, Demirkaya said. Some may be in advanced stages, use multiple medications or receive additional treatments for specific symptoms.
Prolonged hunger and dehydration may increase fatigue, a common complaint among MS patients. In addition, treatments that affect the immune system require careful consideration of infection risk, he said.
Stroke is more common in older adults, particularly those over 65, with risk increasing further after age 75, Demirkaya said. Many stroke survivors consult their doctors about whether they can fast.
For these patients, physicians must assess not only whether their neurological condition is stable, but also whether blood sugar and blood pressure are controlled, whether heart disease treatments are being maintained and whether medications can be properly scheduled during the fasting period, he said.
During Ramadan, neurology outpatient clinics and emergency departments most frequently see patients with headaches, Demirkaya said. Changes in diet, elevated blood pressure, sleep deprivation and reduced fluid intake can all contribute to increased headache complaints.
He urged patients to seek medical attention promptly if they experience symptoms related to their condition.
“A balanced approach is essential, one that protects health while allowing individuals to fulfill their religious obligations,” Demirkaya said.
