Climate Change Commission


15 April 2024

Climate Change and Epilepsy: Neuroscientific Perspectives on Environmental Interactions

In epilepsy, a chronic neurological disorder known for its tendency to generate seizures, 45–50 million people are affected globally, and 2.4 million people receive a diagnosis each year. Climate change and environmental factors like air pollution, temperature changes, stress, and neuro-infections have a significant impact on epilepsy patients, making their symptoms worse and increasing the risk of seizures. Epilepsy is influenced by a variety of factors including genetic predispositions and environmental influences. The scientific community has shown growing interest in the effects of climate change and related environmental changes on epilepsy in recent years. This composition aims to address the intricate relationship between climate change, environmental factors, and epilepsy, emphasizing the consequences for public health interventions.

Climate change, mainly caused by global warming, is linked to increased air pollution, which presents substantial health hazards on a global scale. Air pollutants like particulate matter (PMs), ultrafine particles (UFPs), carbon monoxide (CO), nitrogen oxides (NOx), sulfur dioxide (SO3), and ozone (O3) have been linked to worsening neurological symptoms in patients with epilepsy. The exacerbation is caused by immune-mediated interactions between genes and the environment, resulting in neuroinflammation, tissue damage, and heightened epileptogenic activity.

Climate change-induced temperature changes also affect epilepsy. Elevated body temperature, such as hyperthermia caused by climate, can induce seizures, and exacerbate seizure frequency, especially in disorders like Dravet syndrome. Research has demonstrated a negative correlation between seizures and low atmospheric pressure, high humidity, and stable weather conditions. Unstable weather patterns have been associated with higher seizure frequency, highlighting the importance of temperature changes in controlling seizures and preventing brain damage. The relationship between raised body temperature and seizures involves various mechanisms, including genetic susceptibility through channelopathies (SCN1A/B, voltage-gated Na+ channels, GABA-A receptor-coupled), alterations in ion channel permeability (temperature-sensitive TRPV channels, L-type Ca2+ channels), activation of the innate immune system (pro-inflammatory cytokines such as IL-1b, TNF, and IL-6), and induction of hyperventilation alkalosis.

Stress, a significant factor in epilepsy, is also a consequence of climate change. Elevated cortisol levels have been associated with interictal epileptiform discharges and reduced overall functional connectivity in the EEG during stress-induced seizures. Fluctuations in temperature caused by climate change can disturb sleep patterns, worsening epilepsy management problems related to lack of sleep. The urban heat island effect exacerbates fatigue and sleep disturbances, leading to a higher risk of seizures.

Climate change affects the distribution and occurrence of neuro-infections such as malaria and neurocysticercosis. Increasing of 2–3°C may increase the population at risk for malaria by 3–5%, influencing transmission intensity and range, potentially leading to a rise in cases of cerebral malaria-related epilepsy to the already 247 million cases of malaria reported in 2021. Warmer climates promote the transmission of neurocysticercosis and may be the primary cause of epilepsy in approximately 1% of the population in endemic countries and up to 30–50% of cases in certain temperate regions of Africa, Asia, and Latin America.

Particular epilepsy syndromes like Dravet syndrome (SCN1A), Ohtahara syndrome (SCN2A 1270G>A; p.V424M (2q24.3), ARX (Xp22.13), CDKL5 (Xp22), SL25A22 (11p15.5), and STXBP1 (9q34.1)), West syndrome, and Panayiotopoulos syndrome are prone to being influenced by climate-related factors. Individuals with Dravet syndrome suffer from seizures that do not respond to medication and are worsened by fever and increased temperatures caused by climate change. Fever-induced seizures are prevalent in Ohtahara syndrome and Panayiotopoulos syndrome, underscoring the susceptibility of epilepsy patients to environmental changes.

The convergence of climate change, environmental elements, and epilepsy poses a complex challenge with extensive consequences for public health. To tackle this issue, a thorough grasp of the neurobiological mechanisms that connect climate change and epilepsy is necessary. By clarifying these mechanisms, researchers can create specific strategies to reduce the effects of environmental changes on epilepsy patients, ultimately enhancing their quality of life and well-being.


  1. Gulcebi, M. I., Bartolini, E., Lee, O., Lisgaras, C. P., Onat, F., Mifsud, J., Striano, P., Vezzani, A., Hildebrand, M. S., Jimenez-Jimenez, D., Junck, L., Lewis-Smith, D., Scheffer, I. E., Thijs, R. D., Zuberi, S. M., Blenkinsop, S., Fowler, H. J., Foley, A., & Sisodiya, S. M. Epilepsy Climate Change Consortium (2021). Climate change and epilepsy: Insights from clinical and basic science studies. Epilepsy & behavior: E&B, 116, 107791.
  2. Aledo-Serrano, A., Battaglia, G., Blenkinsop, S., Delanty, N., Elbendary, H. M., Eyal, S., Guekht, A., Gulcebi, M. I., Henshall, D. C., Hildebrand, M. S., Macrohon, B., Madaan, P., Mifsud, J., Mills, J. D., Neill, K. H., Romagnolo, A., Vezzani, A., & Sisodiya, S. M. (2023). Taking action on climate change: Testimonials and position statement from the International League Against Epilepsy Climate Change Commission. Seizure, 106, 68–75.
  3. Podlaha, A., Bowen, S., Lörinc, M., Kerschner, B., Zheng-Ng, J. & Ondřej, H. 2021 Weather, Climate and Catastrophe Insight (2022). Impact Forecasting. AON plc.
  4. Landrigan, P. J., Stegeman, J. J., Fleming, L. E., Allemand, D., Anderson, D. M., Backer, L. C., … Rampal, P. (2020). Human Health and Ocean Pollution. Annals of Global Health, 86(1), 151.DOI:
  5. Sisodiya S. M. (2023). Climate change and the brain. Brain: a journal of neurology, 146(5), 1731–1733.
  6. Joseph, P., Leong, D., McKee, M., Anand, S. S., Schwalm, J.-D., Teo, K., Yusuf, S. (2017). Reducing the Global Burden of Cardiovascular Disease, Part 1. Circulation Research, 121(6), 677–694. doi:10.1161/circresaha.117.30890
  7. Bongioanni, P., Del Carratore, R., Corbianco, S., Diana, A., Cavallini, G., Masciandaro, S. M., Dini, M., & Buizza, R. (2021). Climate change and neurodegenerative diseases. Environmental research, 201, 111511.
  8. GBD 2016 Neurology Collaborators (2019). Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. Neurology, 18(5), 459–480.
  9. World Health Organization: WHO. (2023). Epilepsy.
  10. Pacheco-Barrios, K., Navarro-Flores, A., Cardenas-Rojas, A., de Melo, P. S., Uygur-Kucukseymen, E., Alva-Diaz, C., Fregni, F., & Burneo, J. G. (2021). Burden of epilepsy in Latin America and The Caribbean, 1990–2019: a Global Burden of Disease study. Scientific reports, 11(1), 19168.
  11. Keste D, Acevedo C, Medina MT Tomás Mesa, Jorge Rodríguez; Epilepsy in Latin America; Technical document based on presentations at the international workshop in Santiago, Chile, in August 2013.
  12. Fisher, R. S., Acevedo, C., Arzimanoglou, A., Bogacz, A., Cross, J. H., Elger, C. E., Engel, J., Jr, Forsgren, L., French, J. A., Glynn, M., Hesdorffer, D. C., Lee, B. I., Mathern, G. W., Moshé, S. L., Perucca, E., Scheffer, I. E., Tomson, T., Watanabe, M., & Wiebe, S. (2014). ILAE official report: a practical clinical definition of epilepsy. Epilepsia, 55(4), 475–482.
  13. Devinsky, O., Vezzani, A., O'Brien, T. J., Jette, N., Scheffer, I. E., de Curtis, M., & Perucca, P. (2018). Epilepsy. Nature reviews. Disease primers, 4, 18024.
  14. Rakers, F., Walther, M., Schiffner, R., Rupprecht, S., Rasche, M., Kockler, M., Witte, O. W., Schlattmann, P., & Schwab, M. (2017). Weather as a risk factor for epileptic seizures: A case-crossover
  15. Ewa Motta, Anna Golba, et al. (2011). Seizure frequency and bioelectric brain activity in epileptic patients in stable and unstable atmospheric pressure and temperature in different seasons of the year- a preliminary report. Neurol Neurochir Pol. 45 (6):561-566
  16. den Heijer, J. M., Otte, W. M., van Diessen, E., van Campen, J. S., Lorraine Hompe, E., Jansen, F. E., Joels, M., Braun, K. P. J., Sander, J. W., & Zijlmans, M. (2018). The relation between cortisol and functional connectivity in people with and without stress-sensitive epilepsy. Epilepsia, 59(1), 179–189.
  17. Obradovich, N., Migliorini, R., Mednick, S. C., & Fowler, J. H. (2017). Nighttime temperature and human sleep loss in a changing climate. Science advances, 3(5), e1601555.
  18. Fujii, H., Fukuda, S., Narumi, D., Ihara, T., & Watanabe, Y. (2015). Fatigue and sleep under large summer temperature differences. Environmental research, 138, 17–21.
  19. World Health Organization: WHO & World Health Organization: WHO. (2023). Malaria.
  20. Dasgupta, S. (2018). Burden of climate change on malaria mortality. International journal of hygiene and environmental health, 221(5), 782–791.
  21. Hajison, P. L., Mwakikunga, B. W., Mathanga, D. P., & Feresu, S. A. (2017). Seasonal variation of malaria cases in children aged less than 5 years old following weather change in Zomba district, Malawi. Malaria journal, 16(1), 264.
  22. Ngugi, A. K., Bottomley, C., Kleinschmidt, I., Wagner, R. G., Kakooza-Mwesige, A., Ae-Ngibise, K., Owusu-Agyei, S., Masanja, H., Kamuyu, G., Odhiambo, R., Chengo, E., Sander, J. W., Newton, C. R., & SEEDS group (2013). Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies. The Lancet. Neurology, 12(3), 253–263.
  23. Mewara, A., Goyal, K., & Sehgal, R. (2013). Neurocysticercosis: A disease of neglect. Tropical parasitology, 3(2), 106–113.
  24. World Health Organization: WHO. (2023b). Epilepsy.
  25. Vezzani, A., Fujinami, R. S., White, H. S., Preux, P. M., Blümcke, I., Sander, J. W., & Löscher, W. (2016). Infections, inflammation and epilepsy. Acta neuropathologica, 131(2), 211–234.
  26. Hotez P. J. (2018). Human Parasitology and Parasitic Diseases: Heading Towards 2050. Advances in parasitology, 100, 29–38.
  27. Tahara M, Higurashi N, Hata J, et al. Developmental changes in brain activity of heterozygous Scn1a knockout rats. Front Neurol. 2023; 14:1125089. Published 2023 Mar 14. Doi:10.3389/fneur.2023.1125089
  28. Anwar, A., Saleem, S., Patel, U. K., Arumaithurai, K., & Malik, P. (2019). Dravet Syndrome: An Overview. Cureus, 11(6), e5006.
  29. Hernandez, A., Kiriakopoulos, E. & Wirell, E. (2019). Ohtahara Syndrome. Epilepsy Foundation.,begin%20before%20age%203%20months.
  30. Cross, H. (2014). Enzephalopathie, epileptische, frühinfantile Form. Orphanet.
  31. Liang, J. S., Lin, L. J., Yang, M. T., Wang, J. S., & Lu, J. F. (2017). The therapeutic implication of a novel SCN2A mutation associated early-onset epileptic encephalopathy with Rett-like features. Brain & development, 39(10), 877–881.
  32. Steel, D., Symonds, J. D., Zuberi, S. M., & Brunklaus, A. (2017). Dravet syndrome and its mimics: Beyond SCN1A. Epilepsia, 58(11), 1807–1816.
  33. Caraballo, R., Fortini, S., & Espeche, A. (2021). Spontaneous remission of West syndrome associated with acute infection and fever in five patients. Epilepsy research, 174, 106663.
  34. Salar, S., Moshé, S. L., & Galanopoulou, A. S. (2018). Metabolic etiologies in West syndrome. Epilepsia open, 3(2), 134–166.
  35. Daniels, D., Knupp, K., Benke, T., Wolter-Warmerdam, K., Moran, M., & Hickey, F. (2019). Infantile Spasms in Children with Down Syndrome: Identification and Treatment Response. Global pediatric health, 6, 2333794X18821939.
  36. Weir, E., Gibbs, J., & Appleton, R. (2018). Panayiotopoulos syndrome and benign partial epilepsy with centro-temporal spikes: A comparative incidence study. Seizure, 57, 66–69.
  37. Emmady PD, M Das J. (2023). Benign Occipital Seizure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
  38. Vigevano, F., Specchio, N., & Fejerman, N. (2013). Idiopathic focal epilepsies. Handbook of clinical neurology, 111, 591–604.
  39. Kivity, S., Oliver, K. L., Afawi, Z., Damiano, J. A., Arsov, T., Bahlo, M., & Berkovic, S. F. (2017). SCN1A clinical spectrum includes the self-limited focal epilepsies of childhood. Epilepsy research, 131, 9–14. 

Daniel San-Juan M.D., MSc., Epilepsy Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico

Uriel Antonio Guechi Rodríguez M.D,  Faculty of Medicine, Universidad de Guadalajara, Jalisco, México 

Getting on track to low-carbon conferences

13 March 2024

Participation in international conferences is an important part of academic life, and as medical professionals and researchers, we should take climate health into consideration when planning our travels.

It has been estimated that conference carbon emissions may be as high as 3,500 kg CO2 per participant (the equivalent of about 13 London-Rome return flights), with air travel being the main contributor. Medical conferences seek to improve people’s health, yet contributing to climate change is likely to have a significant adverse effect - by 2050 climate change, driven by greenhouse gas emissions, could result in an excess of 250,000 deaths a year and health risks will increase with higher temperatures.

The Tyndall Centre for Climate Change Research recently identified the actions required by academia to reduce air travel, including the need to normalise the avoidance of flying by sharing advice and experiences. In this blog we hope to contribute to this ambition by highlighting some of the benefits of rail travel and providing useful tools to facilitate it.

Source: EcoPassenger (, assuming average load factors and conventional gasoline engine for car travel. Air travel calculation takes into account the climate effects of carbon dioxide and other greenhouse gas emissions.
Source: EcoPassenger, assuming average load factors and conventional gasoline engine for car travel. Air travel calculation takes into account the climate effects of carbon dioxide and other greenhouse gas emissions.

Travelling by train has been found to be the most effective of a number of intervention scenarios in reducing conference carbon emissions. There are several simple tools you can use to compare emissions for upcoming trips. The ICAO Carbon Emissions Calculator calculates emissions associated with air travel, and in this graph, we illustrate indicative carbon emissions calculated by EcoPassenger for a one-way journey from London, UK, to Rome, Italy.

Whilst for many, train travel to a conference on the other side of Europe might sound off-putting, it is possible (even for those of us based in the north of the UK) to reach many European destinations within a day of travelling. When the full travel time associated with flying, including travel to the airport, check-in, flight times, waiting for baggage, and travel from the airport to a city-centre destination, is taken into account, rail travel is even closer to the journey time by air. For example, travel from Newcastle to Cologne would take around five hours by plane while the train journey is around eight hours via London and Brussels. We recently travelled from Newcastle to Milan for a European conference, departing early in the morning from Newcastle and arriving in Milan just after dinner. If overnight trains, such as the Brussels to Berlin service, are factored-in then more distant destinations are possible within a day’s travel.

One off-putting factor may be the perceived additional effort of identifying a rail route and travel providers. There are, however, user-friendly resources to help with this for European rail travel including The Man in Seat Sixty-One and, and apps like Trainline or RailEurope provide an online booking system for cross-Europe train journeys. The major barrier remains the cost of train travel compared to the equivalent flight. Train journeys can often be two or three times more expensive than the equivalent flight, and thus we will require support from universities to offset the additional cost in the name of reducing our academic carbon footprints.

Although the costs, in terms of time and money, of train travel may be higher than those of flying, there are many benefits that arise from going by train. For a start, rail journeys tend to begin and end in city centres rather than far-flung airports. The on-train experience is mostly a world apart from that of flying, where usually you’re able to sit at a table with a large window, work on your laptop using the free on-board wi-fi, step off for a breath of fresh air at intermediate stations, stroll to the buffet car for a coffee or even sit in the restaurant car for lunch. Thus, time spent travelling by train needn’t be dead time but can be spent productively working on that conference presentation or keeping on top of emails.

As academics and clinicians we have a responsibility to take action. We have a duty of leadership, for if we are not willing to reduce our own emissions from our professional activities then why should we expect others to do so? Reducing our emissions through carbon neutral conferences and thus limiting climate change is essential to protect both the planet’s and its people’s health.

Dr Stephen Blenkinsop, Senior Lecturer, Newcastle University, ILAE Climate Change Commission member

Dr Alistair Ford, Senior Lecturer in Geospatial Data Analytics, Newcastle University

An update from the ILAE Climate Change Commission chair

10 April 2023

Since July 2022, members of the ILAE’s first ever Climate Change Commission have written short topical pieces around many different issues related to climate change, some directly related to epilepsy, others more indirectly, but all focused on the challenge of climate change with its likely impacts for people with epilepsy. The members have diverse backgrounds and work in different contexts around the world. Our personal journeys to join the Commission were recently published (Seizure 2023; 106:68-75). At the first meeting of the Commission, we all spoke briefly to relate our concerns about the climate: it was good to hear how the members had come to their own particular perspectives and how concerns about climate change impacts for people with epilepsy were more widely shared than I had envisaged. In the Commission’s terms of reference, one of our stated aims is to “raise awareness amongst, and educate, ILAE membership about the impact of climate change (including through the promotion of research, knowledge and understanding) on people with epilepsy and epilepsy professionals, and of their own professional contributions to climate change: achieving climate literacy.”

As with many of our stated aims, the targets are ambitious. We may not achieve them during this inaugural Commission. We are small players in the climate arena, and our efforts alone will not halt climate change. But we are in this arena, we are all in this challenge together. We do all have a voice, we all have both a responsibility and a capacity to act. As noted in the recent Intergovernmental Panel on Climate Change “Climate Change 2023: Synthesis Report”, a ‘survival guide for humanity’, we can all make a difference: “Demand-side measures (includes socio-cultural and behavioural change) and new ways of end-use service provision can reduce global greenhouse gas emissions in end-use sectors by 40–70% by 2050,” and “With policy support, socio-cultural options and behavioural change can reduce global greenhouse gas emissions of end-use sectors by at least 5% rapidly, with most of the potential in developed countries, and more until 2050, if combined with improved infrastructure design and access. Individuals with high socio-economic status contribute disproportionately to emissions and have the highest potential for emissions reductions, e.g., as citizens, investors, consumers, role models, and professionals.” Many of us, as epilepsy professionals, inevitably fall into the world’s richest top 10%, who together account for about 50% of the global greenhouse gas burden.

We have a long way to go, but the need is pressing. The latest report is cast in terms of survival – the survival of our ways of life, of biodiversity on this planet, and the hopes of generations to come. As the ILAE Climate Change Commission, we hope that we can do something to this end, that we can raise awareness and help take action. We will continue to work on this over the coming months, and hope that you will remain engaged and active. We will be changing the style and content of the items in the newsletters; we invite the membership to propose items for inclusion (contact me directly on; and we are pleased also to announce prizes for research and actions in climate change, to be awarded in person or remotely at the upcoming International Epilepsy Congress in Dublin this September. We are also holding a webinar engaging with the World Federation of Neurology and European Academy of Neurology on 15 May 2023, International Climate Change Day.

To lead the lives we want, we have to change the lives we lead. At ILAE, we hope to do so together, as part of our efforts to tackle both epilepsy and climate change.     

Sanjay Sisodiya, ILAE Climate Change Commission chair

6 March 2023

Could lifestyle changes of COVID-19 pandemic help combat climate change?

The SARS-CoV-2 pandemic and climate change are two major global challenges humans are facing. While climate change is a long-term phenomenon threatening all living beings, we have been under the stressful impact of coronavirus disease since 2020 when it spread all over the world and was declared a Public Health Emergency of International Concern by WHO.1 The pandemic is a new phenomenon; a significant number of scientific studies started to be published immediately after the outbreak to collect information and find the best pharmacotherapy and management regarding its devastating health effects. It has changed so many lives with its associated mortality and morbidity and marked social and economic implications in a very short period. We had to implement urgent, major lifestyle changes during the pandemic. Especially during the peak period of the COVID-19 pandemic, everyday life almost stopped, whilst hospitals were often working beyond their capacity to save people. Conversely, the climate emergency, due to accumulation of greenhouse gas emissions in the atmosphere that results in rising temperatures, has a long history. The number of scientific papers declaring the urgency for acting against the pervasive effects of climate change on our health has been increasing as episodes of extreme weather events and temperature fluctuations have become more frequent and intense in recent decades, causing severe health hazards.2-4 We have experienced the pressure of the interaction of both global crises on the health systems as well; extreme weather events such as floods, heatwaves, and wildfires all over the world with the confluence of COVID-19 caused thousands of additional deaths.1,5

Besides highlighting the relationship between climate change and specific diseases, we need to consider mitigation and adaptation efforts to cope with its consequences for human beings, particularly for people with mental health issues or elderly people with chronic diseases. The consequences of heatwaves in Europe in 2003 and 2006 indicated that people with cardiovascular or neuropsychiatric diseases were at high risk for the adverse effects, including mortality, of the extreme weather.2-3 Since reduction of carbon emissions is essential to tackle climate change, lifestyle changes which were developed with the pandemic might usefully be examined for their potential to combat climate change and its consequences. Let’s consider the significant countermeasures and focus on what we experienced in our lifestyles during the pandemic. The most profound was the lockdown. Many industries, commercial and transportation activities came to a stop several times almost all over the world. Moreover, there were restrictions on travel and the workplace. Most people started to work from home or even do shopping via mobile phone applications, and online meetings and telehealth systems helped professionals provide healthcare. At first glance, it seems that almost all these lifestyle changes would have a useful potential to mitigate the course of climate change, since many are directly associated with (reduced) greenhouse gas emissions. Moreover, as expected, some studies found short-term reductions in greenhouse gas emissions, decreases in particulate matter and air pollution.6-7 However, lockdowns came at an enormous cost, and whilst greenhouse gas emissions decreased for a short period with the lockdowns and travel restrictions, there were increases in waste production and reductions in waste recycling, major negative effects of the pandemic on environment.8-9 We can learn from those experiences to manage change in better ways.

In conclusion, humanity managed its behaviour as an important part of the battle against COVID-19. Perhaps we may consider lifestyle changes that could play a supporting role in fighting against green gas emissions; less traveling, consuming healthy food, avoiding products with lots of packaging, or increasing waste recycling.


  1. WHO 2022, Coronavirus disease (COVID-19) pandemic (
  2. Stöllberger C, Lutz W, Finsterer J. Heat-related side-effects of neurological and non-neurological medication may increase heatwave fatalities. Eur J Neurol. 2009 Jul;16(7):879-82.
  3. Sommet A, Durrieu G, Lapeyre-Mestre M, Montastruc JL; Association of French PharmacoVigilance Centres. A comparative study of adverse drug reactions during two heat waves that occurred in France in 2003 and 2006. Pharmacoepidemiol Drug Saf. 2012 Mar;21(3):285-8.
  4. Thompson R, Landeg O, Kar-Purkayastha I, Hajat S, Kovats S, O'Connell E. Heatwave Mortality in Summer 2020 in England: An Observational Study. Int J Environ Res Public Health. 2022 May 18;19(10):6123.
  5. Romanello M, Di Napoli C, Drummond P, Green C, Kennard H, Lampard P, Scamman D, Arnell N, Ayeb-Karlsson S, Ford LB, Belesova K, Bowen K, Cai W, Callaghan M, Campbell-Lendrum D, Chambers J, van Daalen KR, Dalin C, Dasandi N, Dasgupta S, Davies M, Dominguez-Salas P, Dubrow R, Ebi KL, Eckelman M, Ekins P, Escobar LE, Georgeson L, Graham H, Gunther SH, Hamilton I, Hang Y, Hänninen R, Hartinger S, He K, Hess JJ, Hsu SC, Jankin S, Jamart L, Jay O, Kelman I, Kiesewetter G, Kinney P, Kjellstrom T, Kniveton D, Lee JKW, Lemke B, Liu Y, Liu Z, Lott M, Batista ML, Lowe R, MacGuire F, Sewe MO, Martinez-Urtaza J, Maslin M, McAllister L, McGushin A, McMichael C, Mi Z, Milner J, Minor K, Minx JC, Mohajeri N, Moradi-Lakeh M, Morrissey K, Munzert S, Murray KA, Neville T, Nilsson M, Obradovich N, O'Hare MB, Oreszczyn T, Otto M, Owfi F, Pearman O, Rabbaniha M, Robinson EJZ, Rocklöv J, Salas RN, Semenza JC, Sherman JD, Shi L, Shumake-Guillemot J, Silbert G, Sofiev M, Springmann M, Stowell J, Tabatabaei M, Taylor J, Triñanes J, Wagner F, Wilkinson P, Winning M, Yglesias-González M, Zhang S, Gong P, Montgomery H, Costello A. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet. 2022 Nov 5;400(10363):1619-1654. doi: 10.1016/S0140-6736(22)01540-9. Epub 2022 Oct 25. Erratum in: Lancet. 2022 Nov 3;: Erratum in: Lancet. 2022 Nov 19;400(10365):1766.
  6. Khojasteh D, Davani E, Shamsipour A, Haghani M, Glamore W. Climate change and COVID-19: Interdisciplinary perspectives from two global crises. Sci Total Environ. 2022 Oct 20;844:157142.
  7. Rugani B, Caro D. Impact of COVID-19 outbreak measures of lockdown on the Italian Carbon Footprint. Sci Total Environ. 2020 Oct 1;737:139806. 
  8. Zambrano-Monserrate MA, Ruano MA, Sanchez-Alcalde L. Indirect effects of COVID-19 on the environment. Sci Total Environ. 2020 Aug 1;728:138813.
  9. Patrício Silva AL, Prata JC, Walker TR, Duarte AC, Ouyang W, Barcelò D, Rocha-Santos T. Increased plastic pollution due to COVID-19 pandemic: Challenges and recommendations. Chem Eng J. 2021 Feb 1;405:126683. 

By Medine Gulcebi Idriz Oglu, Sustainability Engagement Task Force Member

22 February 2023

To go or not to go? That is the question.

This year I opted not to go to the American Epilepsy Society Annual Scientific Meeting in Nashville. I live in New Zealand which, as anyone who has visited knows, is one of the best countries in the world! The only problem is we are far away from everywhere. To visit any other country requires a relatively long flight. A short flight from New Zealand is to Australia, which takes 4 to 10 hours depending on the destination coast. To get to North America entails 12 to 18 hours of flying, and Europe takes a minimum of 24 hours flying time. Despite the fact that Air New Zealand is making positive moves to decreasing carbon emissions (they aim to have their first zero emissions aircraft flying by 2026), these long flights have a big carbon footprint.

My first AES meeting was in 1996, and I have been every year since, apart from the COVID years of 2020 and 2021, which I attended online. To be honest, neither of those years were that great for me online – not because of the technology or the content of the meeting but rather the way I tried to fit an online meeting into my otherwise busy life. I tried to attend the meeting mostly live, which was a problem for the time zone difference and the on-demand content took a while to become available. Despite my best intentions, I just didn’t have time in my busy life to watch the online content. I naively thought I would “fit it in” but of course, like the rest of you, there is no time in my life to just “fit things in”!

This year I did things differently. Firstly I “went” to the online meeting in early January at my home rather than in December in Nashville. This meant all the online content I wanted to watch was readily available. Secondly, I took conference leave just like I would have if I went to the meeting in person – I cancelled all clinics, teaching and meetings and put my out of office message on. Normally going to the AES takes 7 days – 1.5 days to get there, 4 days at the meeting and 1.5 days to get back. This year I took just 4 days leave.

It was a fantastic AES meeting. In many ways one of the best AES meetings I have ever “been” to. This is why:

  • The IT aspect of it was perfect – in fact some might say more than perfect! Being able to listen to the sessions at double speed meant I was able to get in twice as much content as I would have if I was actually at the meeting. Double speed for me as an English speaker was very understandable, albeit most of the speakers sounded like they were chipmunks, and you do have to concentrate – no checking the emails.
  • In the four days I listened to roughly 42 hours of content. When I actually go to the meetings, I often spend so much time in task-force meetings and research meetings that I find it hard to get to much AES content.
  • I didn’t miss out on any session that in Nashville ran concurrently at the same time as other sessions I wanted to go to. I could listen to both sessions.
  • I could go into a session and quickly skip a speaker that wasn’t that engaging or a topic that I wasn’t really interested in. If I am at the meeting – I either have to sit through these or leave that session which means I can miss out on something magical from the next speaker.
  • I could rewind and replay bits I didn’t get, or stop the presentation when I wanted to write notes from the slides (did somebody say screen dump? ...of course I didn’t do that...) .
  • I could very effectively multitask mundane tasks – I could make dinner, make the beds, do the laundry and even ride my exercycle each day.
  • I was very comfortable – I could watch the content anywhere – at my desk, sitting on the couch, lying in bed, tanning outside in the sun.

Of course, there are downsides to not going to the meeting in person. I missed out on social interaction with my colleagues and collaborators, who have become friends, and debriefing with them after a good (or bad) session. I missed out on impromptu networking opportunities, and I missed out on some of the in person ILAE task force and commission meetings – although I did go to some of those on ZOOM back in December when they happened.

Back on the upside – I didn’t need to spend three days on a plane, I didn’t need to adjust to a 19-hour time difference on the way over and then on the way back, I got to go to bed each night with my husband and oh yeah – I also made a bit of a dent in my carbon footprint!

On reflection, I don’t need to go the AES in person every year – going every second year will be fine. I would highly recommend having a good go at “going to” the AES via the on-demand content at home – it will not only be good for the planet, but it might also be good for you!

Professor Lynette Sadleir, University of Otago, Wellington, Sustainable ILAE Task Force member

7 February 2023

Where did all the rain come from?

In 2022, widespread rainfall across northern and eastern Australia has led to extreme flooding. This long run of wet weather has been driven by a highly unusual sequence of three consecutive years of La Niña events.1 During these events warm surface water is pushed towards the seas north of Australia by strong trade winds that blow west across the Pacific Ocean, resulting in higher than normal rainfall.2 The inverse effect is experienced on the other side of the Pacific where 60% of the US has recently been designated a drought zone.3

In contrast, during El Niño events trade winds weaken or reverse, leading to warmer surface water in the central Pacific.2 This translates to less moisture north of Australia making severe bushfire seasons like the 2019-20 black summer bushfires more likely. This alternation between warm phase El Niño and cold phase La Niña events, known as the El Niño–Southern Oscillation (ENSO), is the most important climate phenomenon on Earth driving interannual changes in global climate.2

Monthly sea surface temperature anomalies for NINO3.4 region

The Indian Ocean dipole is another climate driver that in parallel has also increased rainfall in Australia during 2022.1 It is created by differences in sea surface temperature between the eastern and western Indian Ocean.4 The current negative dipole has lasted for the past two years (the first time this has ever happened since reliable recording began in 1960) and has concentrated warmer water in the eastern Indian Ocean leading to more moisture-rich air flowing towards Australia.1 While these negative Indian Ocean dipoles are typically associated with above-average rainfall, extreme positive Indian Ocean dipoles can intensify bushfires, as they did in Australia in 2019-20.

Between 1910 and 2020 Australia’s climate warmed by about 1.47C.1 During this period high-intensity short-duration rainfall events have produced a greater proportion of the total rainfall.1 If the planet continues to warm it is projected extreme La Niña and El Niño events will increase.5 Australian families with epilepsy are directly impacted by flood damage to their homes as well as to community and transport infrastructure. The stress created by these more frequent natural disasters, together with increased unseasonal changes in temperature, has the potential to exacerbate seizure events.


  1. Australian Government Bureau of Meteorology:
  2. Cai et al 2021. Changing El Niño–Southern Oscillation in a warming climate. Nature Reviews 2:628-644
  3. S. Drought Monitor:
  4. Abram et al 2020. Palaeoclimate perspectives on the Indian Ocean Dipole. Quaternary Science Reviews 237:1-20. Invited Review
  5. Australian Research Council Centre of Excellence for Climate Extremes, Monash University:

Michael Hildebrand, Co-Chair, Task Force 1: Sustainable ILAE, ILAE Climate Change Commission

11 January 2023

Climate change and mitigation in developing countries: Efforts and prospects in India

Climate change, or global warming, is an emergency with dire consequences for humankind. The impact has been multi-fold including health, economic, agricultural, industrial, and trade sectors. Both developing and developed countries are affected. During the 1997 Kyoto Protocol, the Group of 77 (G77), a group of developing countries (134 member countries at present), asserted the need for a directive for developed countries to lead the fight against global warming. The 2015 Paris Agreement upheld the provision of financial support for developing countries for fighting climate change. However, with changing times, all nations need to work hand-in-hand for the common goals of climate change mitigation, climate equality, and a sustainable future. 

India emits 7% of global greenhouse gas emissions.1 Home to around 17% of the world’s population, Indian per capita emissions are nearly half the world average.2 With a National Action Plan on Climate Change (NAPCC) in place, India is working towards a shift to sustainable and renewable sources of energy.3,4 Also, the voluntary target of reducing the emissions intensity of Indian GDP by 21% over 2005 levels by 2020 has been achieved. The implementation of Bharat stage VI emission norms with effect from 1 April 2020, and the electric vehicle empowerment scheme, are admirable. However, these efforts are still not enough and continual striving in this direction is much needed.

The impact of climate change perceived here has been significant. Being a tropical and subtropical country, temperature fluctuations and heat waves are frequent. Natural calamities including landslides, floods, droughts, and cyclones are not uncommon. Climate change not only affects the physical and mental health of the general public, but also people with acute and chronic disorders.5 Although not assessed or published, the impact on the persons with epilepsy (PWE) including children with epilepsy (CWE) in the Indian subcontinent is likely tremendous due to the huge burden of epilepsy, especially secondary or structural epilepsy. Fever and heat stress being threshold-lowering factors for seizures for many people, the prevalence and incidence of febrile seizures, breakthrough fever-triggered seizures, and respiratory tract diseases including infections (due to air pollution) in CWE are likely to increase.6 Similarly, respiratory co-morbidities in PWE are likely to increase.

Although these aspects would be better captured on a population level over the years, many clinicians (including me) come across CWE (especially genetic epilepsies) with fever-triggered convulsive seizures in overcrowded, resource-limited public health setups during the heat waves. Also, many CWE have co-morbid neurodevelopmental disabilities and are even more predisposed to these effects due to several reasons such as inability to convey their needs, dehydration due to heat waves, and poor thirst mechanisms. These are a common occurrence in day-to-day clinical practice, but the causation analysis for these episodic deteriorations is difficult in resource-constrained settings unless a focused study is done. With the setting up of several registries and multicentre collaborations, Indian researchers and clinicians can work in collaboration with developed and developing countries on climate change and epilepsy. 

Over the last three years, the recent COVID-19 pandemic taught many lessons to humankind including the value of life, environment, and health. Lockdowns, pandemic restrictions, and the subsequent rise of telemedicine led to a temporary improvement in outdoor air quality and meteorological factors.7,8 The pandemic was a turning point for capacity building and initiation of telemedicine services in developing countries like India. Telehealth services, where applicable, can offer a sustainable solution for reducing healthcare-associated emissions and costs. However, efforts are needed to sustain these services. The concept of green and digital hospitals is also not recent in India. However, this needs to be implemented for establishments beyond hospitals. Governments, organizations, community, and individuals - everyone has a part to play in this movement. It is rightly said, 'Great things are a result of several little things collectively done right!'


  1. Emissions Gap Report 2019. UN Environment Programme. 2019.
  2. Greenhouse gas emissions in India. Sept 2018.
  3. India’s Efforts to Combat Global Climate Change | The Official Website of Ministry of Environment, Forest and Climate Change, Government of India (
  4. COP26- What is India doing to combat climate change? Accessed from:
  5. Sharpe I, Davison CM. Climate change, climate-related disasters and mental disorder in low- and middle-income countries: a scoping review. BMJ Open. 2021; 11:e051908. doi: 10.1136/bmjopen-2021-051908.
  6. Maji S, Ghosh S, Ahmed S. Association of air quality with respiratory and cardiovascular morbidity rate in Delhi, India. Int J Environ Health Res. 2018 Oct;28(5):471-490. Doi: 10.1080/09603123.2018.1487045.
  7. Karuppasamy MB, Seshachalam S, Natesan U, Ayyamperumal R, Karuppannan S, Gopalakrishnan G, Nazir N. Air pollution improvement and mortality rate during COVID-19 pandemic in India: global intersectional study. Air Qual Atmos Health. 2020;13(11):1375-1384. doi: 10.1007/s11869-020-00892-w.
  8. Blenkinsop S, Foley A, Schneider N, Willis J, Fowler HJ, Sisodiya SM. Carbon emission savings and short-term health care impacts from telemedicine: An evaluation in epilepsy. Epilepsia. 2021 Nov;62(11):2732-2740. doi: 10.1111/epi.17046.

By Priyanka Madaan, MD, DM, Sustainable ILAE Task Force member

22 November 2022

What can preclinical research add to the epilepsy-climate change discussion?

My lab is based in Dublin, Ireland. Our latitude is 53° North. That lines up with Attu island in Alaska and parts of Newfoundland. But our country experiences a mild climate due to the North Atlantic current and Gulf Stream releasing heat which gets carried over to us. It doesn’t get very hot in the summer and we rarely get snow in winter. But this July we recorded 33°C (91.4°F) outside my building, the hottest day recorded for 135 years. Last night I travelled home late from a work event in Dublin city centre and the temperature outside was 16°C (60.8°F). Historical data from the Irish Meteorological service reports average minimum temperature for November between 1981 and 2010 in Ireland was 4.5°C (40.1°F). At midnight, in mid-November in Ireland in 2022, it was warm enough for a tee-shirt.

Historical temperature data (30 year averages) recorded between 1981 – 2010 from the Dublin airport weather station ( reports the mean November temperature as 7.4oC (45.3oF).
Historical temperature data (30 year averages) recorded between 1981 – 2010 from the Dublin airport weather station ( reports the mean November temperature as 7.4°C (45.3°F).

Although we must be cautious drawing conclusions from individual extreme events (but see, data from the Irish meteorological service and the MaREI Research Centre for Energy, Climate and Marine research and innovation (, show Ireland's climate is rapidly changing in line with global trends.

One of the most obvious impacts of climate change in Ireland can be seen on our East coast. I live about two km from the fastest disappearing stretch of coastline in Ireland. Storm frequency and rising sea levels are hitting this area the hardest with coastline being lost at a rate of more than one metre per year. To protect the crumbling coastline and the houses of those who built close to the edge they have laid massive concrete beach defences to slow the erosion. Using tools provided by, most of Dublin’s coastline as it is today, including where I live, will have disappeared by 2100.

My research uses preclinical models – mainly mice – to study the cell and molecular changes in the brain in genetic and acquired forms of drug-resistant epilepsy. We use the findings to try experimental treatments that might prevent epilepsy developing or reverse its course once it is established. Can we use these models to understand more about the impact of climate change on epilepsy? Perhaps.

concrete beach defences in Ireland

For example, do higher ambient [cage] temperatures accelerate epileptogenesis or increase the frequency or severity of seizures? Are there ages where this effect is more important or types of epilepsy more vulnerable to elevated temperature or changes in humidity? Are constant or irregular temperature rises more harmful?Are neuronal circuits or specific cell types dysfunctional in the parts of the brain that control our body temperature such as the hypothalamus? Do any of the medicines we currently use to control seizures have effects on the temperature control centres in the brain? Would a therapy that corrects temperature control mechanisms have any use in epilepsy?

Research into the brain’s temperature control systems in epilepsy is not a new idea but new technologies and better models allows us to probe with greater sophistication the function of different brain regions and cell types, to manipulate single genes and pathways, and to use a toolbox of animal models which model various types of epilepsy. Bringing these together with population-based and clinical studies may provide answers – a forecast of sorts – of how climate change will impact on the lives of people with epilepsy and perhaps some solutions to the problem we have all had a part in creating.

By David C. Henshall, Ph.D. RCSI University of Medicine & Health Sciences and FutureNeuro SFI Research Centre, Dublin, Ireland, Sustainability Engagement Task Force member

7 November 2022

Keep it Positive – “The Times they are a Changing”

There is a lot of existential gloom around at the moment. It might be in our collective nature to look at the negatives, and certainly the news media do this all the time – we are constantly and instantaneously exposed to all the bad things happening in the world (unless we switch off of course). With regard to the climate crisis, it is now well accepted that humans need to cut carbon emissions by 50% by 2030, and we need to reach net zero by 2050 if we are to limit global warming to 1.5 – 2.0°C (preferably the lower figure). Our combined intelligence and curiosity have got us into this mess, and I believe that our combined intelligence and ingenuity can get us out of it. Changes and solutions are happening, bit by bit, and I think it is important to put some focus on the positive changes that individuals, societies, organisations, businesses, and governments are beginning to make to enable us to reach our climate goals. Things are moving, and we can as a species pull this one around; although it is clear that people are already suffering because of the climate disruption that is in progress. In this piece, I want to highlight two disparate examples of positive change: one at an Irish national level and one at an important international level. We need to focus on the grand goal and keep positive.

The health service in Ireland emits approximately 230 million tonnes of carbon annually. The Health Services Executive (HSE), the government body responsible for the country’s health service, has commissioned a consultancy firm to draw up a national strategy for climate improvement and emissions reduction, and help it with its organisational climate action plan. Already some hospitals are making changes – Limerick University Hospital is currently building a new 60-bed wing to ease capacity pressures in the hospital. This wing will be powered by a new solar panel installation at the hospital. Croom Orthopaedic Hospital, an old traditional hospital complex, is currently upgrading from oil and gas heating to climate-friendly air source heat pumps. Dr. Ana Rakovac, of the Sustainable Healthcare Group (Irish Doctors for the Environment) has also called for sustainable procurement policies, including, for example, moving away from some anaesthetic gases, and changing from meter dose inhalers towards dry power inhalers and mist inhalers.1

'We believe we are reaching a social tipping point across societies. Indeed, four forces – social movements, new economic logic, tech­nological development and political action – are already aligning to push societies across a tipping point in a way that leads us to self-reinforcing virtuous cycles, an Earth for All world'.2

This is a quote from an important new book entitled “Earth for All: A Survival Guide for Humanity” by six authors working with the Transformational Economics Commission. This is led by a group of economic thinkers, scientists, and advocates convened by the Club of Rome, the Potsdam Institute for Climate Impact Research, the Stockholm Resilience Centre, and the Norwegian Business School. The old economic model of mindlessly extracting resources from our planet and focusing on GDP as the only measure of progress is broken. In this Anthropocene era of climate emergency, we need to actively recognise that the planet, and all its species and its ecosystems are interconnected and interdependent. This should be a core principle in everything we do, as individuals, organisations, and as a society – and as healthcare professionals. This book sets out a roadmap for humanity to move away from unsustainable lifestyles facilitated by fossil fuels, polluting production systems and unsustainable agriculture. I would urge colleagues to buy this book, and help be part of the grand solution.


  1. Bowers F. What are hospitals doing to cut their carbon footprint? RTE 19th of October, 2022.

  2. Dixson-Decleve, Gaffney O, Ghosh J, Randers J, Rockstrom, Per Espen A. Earth for All: A Survival Guide for Humanity. A Report for the Club of Rome. September 2022.

Norman Delanty, Co-Chair, Task Force 1: Sustainable ILAE, ILAE Climate Change Commission

17 October 2022

Climate Change and Epilepsy Health Care: A Philippine Perspective

The issue of climate change and the effects on our planet has been brought to light more than 50 years ago with various groups rallying for actions to mitigate climate change itself. However, little has been done at that time in terms of actual implementation of steps to achieve this.1 Nevertheless, since then, the European community and other developed nations have been active in instituting actual measures to decrease their carbon footprints.

Meanwhile, the Philippines signed the treaty on the United Nations Framework on Climate Change in 1992 and thereafter has instituted some legislation and action plans to mitigate the effects of climate change through the Philippine Clean Air Act of 1999 and the Climate Change Act of 2009 that established the national Climate Change Commission whose goal is to develop and institute policies that will mitigate climate change.2 In 2020, the Philippines produced 1.27 metric tons per capita or 0.39% of global carbon emissions, which is slightly lower as compared to our Southeast Asian neighbors.3  This number appears to be minimal and may indicate that the country is not a significant contributor to climate change. On the other hand, the climate trends tracked and projected by the Philippine Atmospheric Geophysical and Astronomical Services Administration (PAGASA) is still quite worrisome because while the Philippines is small contributor, it is a large recipient of consequences. For example, in a comparison of the number of intense tropical cyclones over several decades (climate periods), there has been a consistent increase in the mean number of intense cyclones passing over the Visayas islands of the country from 1951 to 2000, from about 100 cyclones to 125 cyclones per climate period.4 With the increased number of tropical cyclones, there is also an expected increase in rainfall (of up to 300 mm) during the southwest monsoon and transition seasons, particularly in the Luzon and Visayas groups of islands. On the contrary, there is an expected decrease of rainfall in the Mindanao island (rains of up to 2.5 mm) by the year 2050. PAGASA also predicts that by the year 2050, there will be an increase of up to 2.2°C from the baseline mean temperature of the climate period between 1971 to 2000. In fact, they have documented that in 2020, there has already been an increase of 0.9 to 1.8°C from the baseline and that the mean temperature in the country so far in 2022 is 35°C.

The Philippines is made up of 7,641 islands and with its highest point measured only at 2,954 meters above sea level, the danger of rising sea levels are enormous for the lives of Filipinos. A discrepancy in health care delivery is a problem in the country not only because of the unequal distribution of health care workers and services, but also because of the difficulty in traveling to and from one area to the other wherein one has to navigate through land, air, and/or the seas which is largely dependent on weather conditions. With the limited number of neurologists in the country, persons with epilepsy will need to travel through distances for both acute care, such as the management of status epilepticus, and for evaluation and follow-up care. During these trips, one may have to deal with rough seas, turbulent air, or road obstructions due to flooding or landslides. This also applies to delivery of medications and supplies, thus causing limitations to access to maintenance anti-seizure medications. Another issue that will affect epilepsy care in the country is the rising mean temperature. With a majority of households in rural areas without refrigeration and air conditioning, as well as frequent electrical interruptions, storage of medications may be affected, causing decreased efficacy of the medication.5 For example, phenobarbital, which is a popular medication in the country due to its affordability, is recommended to be stored between 15 to 30°C6 but with temperatures often going beyond 35°C, then this may pose a problem in terms of its efficacy. Anecdotal reports of patients having increased frequencies of seizures during warm temperatures have also arisen. Whether this is due to decreased efficacy of their medications or due to a direct effect of high temperatures on seizure activity in the brain, or other factors, is still unknown and needs further investigation. Floods do not only obstruct travel and access to medications and health services, but the more frequent severe flooding and increased humidity thereafter again affects drug provision and efficacy. Teleconsultation is also limited due to climate change effects because of the poor telecommunications infrastructure that easily gets affected by power interruptions, floods, destruction of infrastructures, such as cell towers and power lines, and poor signal. Climate change definitely worsens the vicious cycle of poverty, lack of infrastructure, lack of health manpower and epilepsy care.

While individual changes to mitigate climate change can be done by every person in the country, this is still not widely practiced. In a 2017 study by Bollettino et al.,7 out of 4,368 Filipinos surveyed, only 11.7% felt extremely well-informed about climate change, with a wide discrepancy among different regions. Only 42.2% actually felt that natural disasters were due to climate change. When asked about their perceived consequences and impact of climate change, most Filipinos foresee an impact on destruction of their homes and livelihood. Only individuals from the National Capital Region (69.7%) mentioned an impact on their health; however, this was in the context of harm, injury or illness. Their concept of preparedness likewise is more towards a reactive preparation for earthquakes, flooding, and typhoons instead of establishing strategies to mitigate climate change in the first place.

Much still has to be done for health care in the Philippines in the context of climate change. Public health education towards lobbying and institution of mitigating measures against climate change should be consistently done. For the meantime, we in the health care sector will need to come up with strategies that will address the immediate problems of health care access and delivery in the midst of the inundating effects of climate change in our country.


  1. Nulman, E. (2015). Brief History of Climate Change Policy and Activism. Climate Change and Social Movements, 8–23. doi:10.1057/9781137468796_2
  2. Climate Change Commission (2022).
  3. World Population Review (2022) . CO2 Emissions by Country 2022.
  4. Philippine Atmospheric Geophysical and Astronomical Services Administration (2022). Climate Change in the Philippines.
  5. Philippine Statistics Authority (2010). Characteristics of Poor Families in the Philippines (Findings from the 2008 Annual Poverty Indicators Survey).
  6. PubChem. Phenobarbital. National Library of Medicine National Center for Biotechnology Information.
  7. Bollettino V, Alcayna-Stevens T, Sharma M, Dy P, Pham P, Vinck P. Public perception of climate change and disaster preparedness: Evidence from the Philippines. Climate Risk Management 30 (2020) 100250.

Bernadette C. Macrohon, MD, MClinEpi, MHPEd, Research Sustainability Task Force member

19 September 2022

Climate change and its impact on biodiversity: Why should you care?

Mass extinction events are defined as the loss of the majority of species in a relatively short geological time.1 Over the past 600 million years there have been five mass extinctions events: currently we find ourselves in the midst of number six. This affects all life on earth and the numbers are grim; it is currently estimated that 60% of the world’s largest carnivores and herbivores are classified as threated with extinction,2 the UK’s flying insect population has declined by as much as 60% over the last 20 years,3 and we also have seen drastic changes to coastal ecosystems, with an estimated 35-85% reduction in the global coverage of saltmarshes, mangroves, seagrasses, oyster reefs, kelp beds and coral reefs.4,5  The current extinction rate is estimated to be more than 100 times that of the normal rate throughout geological time. The rapidly changing climate is the major factor driving these ecosystem collapses and subsequent loss of biodiversity.6

Why is biodiversity loss something we should care about? Beyond the major ethical issues, the collapse of numerous ecosystems will have direct impacts on humanity. Human existence is intrinsically intertwined with nature: we depend on the natural environment for food production, water and air filtration, carbon storage, medicinal products, and other intangible values to humans, such as relaxation and mental health benefits. For example, insects pollinate the majority of the world’s crops, keep pest populations under control, and act as the earth’s natural recyclers.3 Without them, crops will fail and food chains will collapse, leading to even more extinction events. Maintaining biodiversity protects our ecosystems from such catastrophic collapses and also provides us with better living environments. Protecting biodiversity is also in the interest of our own professional lives. Where will the next generation of medications for epilepsy come from? How do we know they will not come from the natural world, as for example rapamycin did?

However, it is not all doom and gloom. The earth is resilient. And with proper care and conservation efforts we can see the return of biodiversity. Organisations such as the United Nation Environment Programme (UNEP) have highlighted the importance of conserving and restoring ecosystems, declaring 2021-2030 the “United Nations Decade on Ecosystem Restoration”. 7 The restoration of degraded and destroyed ecosystems will help safe guard biodiversity while also fostering efforts to combat climate change. Further, we as individuals have the power to not only make positive change in our own personal lives, but to influence those around us, and to also push for change at an institutional and governmental level. In the interests of both our personal and professional lives, we must think about the value of biodiversity to all life on earth.


  1. Hallam, A. & Wignall, P. Mass extinctions and their aftermath. (1997).
  2. Ripple, W.J., et al. "Saving the world's terrestrial megafauna." Bioscience 66.10 (2016): 807-812.
  3. Ball, L., Still, R., Riggs, A., Skilbeck, A. & Shardlow, M. The Bugs Matter Citizen Science Survey: Counting insect’splats’ on vehicle number plates. (2022).
  4. Kessouri, F. et al. Coastal eutrophication drives acidification, oxygen loss, and ecosystem change in a major oceanic upwelling system. Proc. Natl. Acad. Sci. U. S. A. 118, (2021).
  5. Saunders, M. I. et al. Bright Spots in Coastal Marine Ecosystem Restoration. Curr. Biol. 30, R1500–R1510 (2020).
  6. Ceballos, G. et al. Accelerated modern human-induced species losses: Entering the sixth mass extinction. Sci. Adv. 1, (2015).
  7. United Nations Environment Programme. "Becoming# GenerationRestoration: ecosystem restoration for people, nature and climate. Nairobi." (2021).

James Mills, Research Sustainability Task Force member

1 September 2022

Why plant-based diets are key in the efforts to stop climate change

The ILAE Climate Change Commission undertakes, in its terms of reference,1 to ensure that as a responsible organization, ILAE quantifies and understands its entire direct and indirect greenhouse gas emissions and commits to reducing emissions to net zero, promoting and establishing sustainable practices across all ILAE activities, including its own operation, meetings or congresses.

While the causes of climate change are numerous, diet is considered one of the most impactful personal and institutional choices to reduce the contribution to climate change and other environmental challenges.2 But diet is not only a major driver of planetary health. Unhealthy diets and malnutrition are the largest global burden of disease and pose a greater risk to morbidity and mortality than does tobacco, alcohol, drug use, and unsafe sex combined.3 The “lose-lose diets” (i.e., unhealthy and environmentally unsustainable) are often characterised as being high in calories, added sugars, saturated fats, processed foods, and red meats.4 Thus, a fully plant-based or plant-predominant (most calories from plants) diet, especially one free from non-processed food, emerges as the best option, both for human and planetary health, according to the EAT-Lancet Commission on healthy diets from sustainable food systems,5 moving in the direction proposed by several international institutions, such as the United Nations and the 2030 Agenda.6,7

But let’s focus on planetary health. Food production is the largest cause of global environmental change. Agriculture occupies about 40% of global land,8 and food production is responsible for up to 30% of global greenhouse gas emissions9 and 70% of freshwater use.10 Moreover, conversion of natural ecosystems to croplands and pastures is the largest factor causing species to be threatened with extinction.11 These eye-opening data propelled a different approach in the Paris agreement, highlighting that its goals were not possible to reach by only decarbonising the global energy system.7 Food production is also one of the key factors.5

Why might a plant-based diet be better for planetary health and an important approach in the fight against climate change? Foods sourced from animals, especially red meat, have relatively high environmental footprints per serving compared to other food groups.12 This has an impact on greenhouse gas emissions, land use and biodiversity loss, and this is particularly the case for animal source foods originating from grain-fed livestock.13 Various studies also show how fully plant-based diets are less environmentally impactful than other formulas, such as pescatarian or vegetarian diets.14 Taking this into account, diets including dairy and egg products are not sustainable enough to contribute to environmental goals. Overall, moving to diets that exclude animal products totally could reduce global greenhouse gas emissions by 49%.15

Few decisions about diet, human health, and environmental sustainability can be made based on absolute certainty because evidence is incomplete, imperfect, and continually evolving. Nonetheless, while considerable uncertainty exists around detailed quantifications, there is currently a high level of scientific certainty and consensus about the overall direction in which diets should change.5

Whilst redefining how we eat needs a focus on complex systems, incentives, and regulations, with communities and governments at multiple levels, by choosing a plant-based diet and promoting it in our individual and institutional activities (for instance in ILAE-organized congresses and meetings), we can contribute to reducing greenhouse gas emissions, help drive demand and provide an example, whilst improving our own health as a co-benefit.


  1. Climate Change Commission of the International League Against Epilepsy. Terms of reference. Available from: (accessed Aug 30th, 2022).
  2. Tilman D, Clark M. Global diets link environmental sustainability and human health. Nature 2014; 515: 518–22.
  3. Global Panel on Agriculture and Food Systems for Nutrition. Food systems and diets: facing the challenges of the 21st century. London: Global Panel, 2016.
  4. Garnett T. Plating up solutions. Science 2016; 353: 1202–04.
  5. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019 Feb 2;393(10170):447-492. doi: 10.1016/S0140-6736(18)31788-4.
  6. Transforming our world. The 2030 Agenda for sustainable development: (accessed Aug 30th, 2022).
  7. Rockstrom J, Gaffney O, Rogelj J, et al. A roadmap for rapid decarbonization. Science. 2017; 355: 1269–71.
  8. Foley JA, Defries R, Asner GP, et al. Global consequences of land use. Science 2005; 309: 570–74.
  9. Vermeulen SJ, Campbell BM, Ingram JSI. Climate change and food systems. Annu Rev Environ Resour 2012; 37: 195–222.
  10. Molden D. Comprehensive Assessment of Water Management in Agriculture. Water for food, water for life: a comprehensive assessment of water management in agriculture. London: Earthscan and Colombo: International Water Management Institute, 2007.
  11. Tilman D, Clark M, Williams DR, Kimmel K, Polasky S, Packer C. Future threats to biodiversity and pathways to their prevention. Nature 2017; 546: 73–81.
  12. Lynch, H.; Johnston, C.; Wharton, C. Plant-based diets: Considerations for environmental impact, protein quality, and exercise performance. Nutrients 2018, 10, 1841.
  13. Gibbs, J.; Cappuccio, F.P. Plant-Based Dietary Patterns for Human and Planetary Health. Nutrients 2022, 14, 1614.
  14. Springmann M, Godfray HC, Rayner M, et al. Analysis and valuation of the health and climate change cobenefits of dietary change. Proc Natl Acad Sci USA 2016; 113: 4146–51.
  15. Poore, J.; Nemecek, T. Reducing food’s environmental impacts through producers and consumers. Science 2018, 360, 987–992.

Ángel Aledo-Serrano, Sustainable ILAE Task Force member

22 August 2022

Tackling climate change and improving sustainability: engaging the epilepsy community

Some ILAE members may have been surprised to learn that as part of its 2021-2025 strategy the ILAE Executive Committee decided to set up a new Climate Change Commission. Several may have queried as to what do climate change and sustainable practices have to do with basic and clinical research in epilepsy and improving outcomes in the management of people with epilepsy?

The answer is a multifaceted one. Several studies are clearly showing that climate change is directly affecting health through increasing temperatures. We are seeing more severe extreme weather events some of which have led to loss of life such as the recent floods following severe storms in Australia and Central Europe, and the deadly avalanche a few months ago in the Dolomites in Italy. 

In recent years, ILAE has recognised that climate change poses a significant threat to the lives and wellbeing of people with epilepsy and to the work of professionals in the field. Studies across human health are also clearly indicating that adverse weather conditions may lead to an increased disease burden. Epilepsy is not an exception and preliminary studies are suggesting certain types of epilepsies may be affected by changes in climate change. Sustainability issues also need to be addressed in our daily work practices, whether in the lab or in the clinic. A recent study has shown that future innovative health care will only succeed if sustainability and climate change issues are addressed by the individual members of the various stakeholders involved. Specifically, ‘health care leaders should be actively considering climate resiliency as an enterprise-wide strategy’ (Deloitte, 2022).

The ILAE Climate Change Commission is taking a three-pronged approach to address emerging issues in this regard, through task forces addressing various aspects of the problem: promoting a sustainable ILAE; engagement with colleagues in various other organisations already working in the area and facilitating research sustainability.

Task Force 2 aims to demonstrate leadership in this field and to engage with other organisations and colleagues which are seeking to achieve the same ends. Various organisations, similar in ethos to ILAE, are already working to integrate sustainable practices into their strategies. They too have established teams driving sustainability efforts by elaborating strategies and best practice policies.

In Task Force 2, we are learning how other organisations are undertaking climate change initiatives and implementing sustainable activities. Such data will be used to compile examples of good practice for ILAE and its member organisations to emulate and thus to spread information on sustainable activities and initiatives to ILAE members and other organizations. Some examples of such organisations are listed below:

  • Centre for Sustainable Healthcare, UK: Since 2008 the Centre for Sustainable Healthcare has engaged health care professionals, patients, and the wider community to understand the connections between health and environment and reduce healthcare’s resource footprint. Their programmes equip healthcare professionals and organisations with methods and metrics for sustainable models of care, addressing aspects such as sustainable specialties programme, carbon footprinting, and triple bottom line analysis and sustainable health care peer networks.
  • The Harvard Global Health Institute, Centre for Climate, Health and the Global Environment is implementing a Climate MD program which aims to help medical professionals add their voice to the national conversation by reaching health leaders through health care journalists and major medical journals, updating clinical guidance to reflect climate risks, and educating medical leaders on the impacts of climate on health. They are also working on preparing a climate-ready health care workforce. Climate MD works with current and future physicians to bring climate change to the bedside and connect climate impacts to the practice of medicine and changing the national media narrative on climate through health messaging.
  • The European Society of Medical Oncology (ESMO), a Swiss-registered not-for-profit organisation, launched a Climate Change Task Force in 2019. The aim is to make ESMO activities more sustainable. The first report produced by this Task Force estimated that on average an attendee at the ESMO annual congress generates about 1500kg of CO2.

Several other examples exist, and we are sure that several ILAE members may be aware of these; we welcome more information in this regard. The ILAE Climate Change Commission will only achieve its aims with the input and support of the wider ILAE community. Moreover, the Commission and Task Force 2 in particular aim to share its own learning with other health care bodies.

Barriers which may limit our capacity to catalyse change can be overcome by effective educational and advocacy actions (Lancet Planetary Health, 2021). Efforts to change our work and research practices will only succeed if we have a better understanding of the main facts about climate change and sustainability and are engaged with the issue. This is what the ILAE Climate Change Commission aims to do.

Janet Mifsud, Co-Chair, Task Force 2: Sustainability Engagement, ILAE Climate Change Commission

20 July 2022

Is our climate changing and does it matter?

With the recent unprecedented heatwave and wildfires in Europe, and following the Climate Change Commission Forum at the European Epilepsy Congress in July, the Commission writes about the evidence for climate change and its significance for people’s health.

Recent heat waves in Europe and flooding in Australia and India have focused the public’s attention on climate change once again. Whilst individually these devastating events don’t tell us about systematic changes in the global climate, collectively they form just part of an extensive and accumulating body of evidence which we can summarise under three main themes.

  1. Historical observations: Long-term records show each of the last four decades has been successively warmer than any preceding decade since 1850. Observed changes in extreme weather like heatwaves, heavy rainfall, and droughts are consistent with a warming planet. Other indicators show that some features of the climate system e.g., changes in global mean sea-level, are at levels unseen in centuries to millennia, and are changing at unprecedented rates.
  2. Physics: The warming properties of greenhouse gases were identified as early as the 19th century, a natural phenomenon called the greenhouse effect. However, human activity has increased concentrations of greenhouse gases, like CO2, to levels higher than they have been at any time in the past 400,000 years.
  3. Climate models: Sophisticated computer models can reproduce many key features in our current climate, but only replicate the observed warming when increased greenhouse gas concentrations are included. Under scenarios of future increases in atmospheric greenhouse gases, these models show consistent projections of increased warming.

This evidence consistently and decisively points to the same conclusion: the world is warming, and according to the UN’s Intergovernmental Panel on Climate Change it is ‘unequivocal that human influence has warmed the atmosphere, ocean and land’.

This is important because climate change impacts are pervasive. Heat is a growing risk, but climate change also contributes to food insecurity and changing disease susceptibility, for example through altered geographical distribution of vector-borne diseases. The impacts of climate change will be more pronounced for warming levels above the Paris Agreement target of 1.5°C of warming.

But global warming is not a problem without a solution.  Urgent collective action to reduce our emissions of greenhouse gases (mitigation), coupled with action to reduce the impact of climate on people and their communities (adaptation), could reduce or even avoid many health risks. The solutions lie with governments and with individuals, as they did with the SARS-2-CoV pandemic. If as professionals we are to ‘do no harm’, then it is our responsibility to act.

For the Climate Change Commission. Dr. Stephen Blenkinsop is a Principal Research Associate in climate change and climate impacts in the School of Engineering, Newcastle University, UK.

21 June 2022

Climate Change Commission Survey

As part of the ILAE's continuing work on climate change and epilepsy, and with more temperature records being broken around the world, this is a good time to understand better the attitudes and concerns around climate change specifically amongst people with epilepsy, their carers and healthcare/research professionals.

Based on a government-run survey of a large sample of the UK population, the Climate Change Commission would like to make available the Climate change and the health of people with neurological conditions survey.

There is a group of researchers, including climate scientists, ready to analyse the data. The hope is that the results will inform sustainable, climate-sensitive strategies in epilepsy across the world.

The survey takes about 15 minutes. Please do feel free to circulate this also to other epilepsy charities with which you may work, your own teams and of course to complete it yourselves. We will feed the results back.

8 June 2022

Climate change is one of the greatest challenges of our time. The new Climate Change Commission has been established to address the consequences of climate change for people with epilepsy, by promoting awareness, research and action. Sustainability is the dominant reaction to climate change, and is already part of the ILAE's ethos, as we see in the upcoming European Epilepsy Congress. In future newsletters, the Climate Change Commission will further promote sustainability initiatives. We look forward to working with the ILAE membership in addressing climate change.