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Seizure trigger factors

www.epinet.org.au/content.asp?contentid=610
 

Seizure trigger factors

Some people, although not all, find that certain factors induce seizures. You may not become aware of your trigger factors unless you keep a seizure diary for a period of time. The following list of trigger factors is a guide but it is by no means an exhaustive list.

Alcohol

Most people with epilepsy can safely drink a moderate amount of alcohol, however some people find even small amounts of alcohol can trigger seizures. Moderate drinking means having 2 standard drinks a day. A standard drink is equal to one small glass of wine (100ml), one middy of full strength beer (285ml) or one nip of spirits (30ml).
Be aware of the quantity of alcohol you drink and don't let anyone persuade you to drink more. Alcohol and antiepileptic medications interact in specific ways. AEDs can make you more sensitive to the sedating effects of alcohol while alcohol reduces the effectiveness of AEDs making seizures more likely. Excessive drinking can result in poor seizure control due to late nights, missed meals, or forgotten doses, while 'hangover' seizures are likely to occur as the alcohol level in the blood falls.

Diet

Coffee, tea and drinks with cola contain caffeine. In some people caffeine can trigger seizures while others are susceptible to having seizures if they miss meals and have a low blood sugar level. Regular meals and eating immediately after getting out of bed in the morning will protect you against large swings in blood sugar levels.

Infections and illness

Children are particularly likely to have more seizures when they develop infections such as tonsillitis and earache. This is possibly due to high temperature and usually eases within a few days.

Allergies may provoke seizures in some people with epilepsy. Diarrhoea and vomiting can trigger seizures because they can prevent your body from absorbing your antiepileptic medication. Ask your doctor what you should do if this occurs.

Lack of sleep

This is a common trigger factor. Everyone differs in the amount of sleep they need, however avoid wild fluctuations in the time you go to bed and make sure you get enough sleep to feel rested.

Menstruation

Some women find that they have more seizures just before or during their menstrual period. This may be caused by a combination of factors such as increased fluid retention, alteration in hormonal levels and alteration in the blood levels of antiepileptic medications. A significant increase in seizure activity at this time is known as catamenial epilepsy. If you notice this happening, discuss it with your doctor. By altering your dose of antiepileptic medication or introducing another medication your doctor may be able to control or ease the problem.

Missed medication

Some people are particularly sensitive to increased seizures when they miss a dose of their antiepileptic medication. The longer the break between doses, the lower your blood levels will go and the greater your chance of having a seizure. If you take your medication erratically or you suddenly stop taking all medication, you may trigger a severe and prolonged seizure or a cluster of seizures that will require hospitalisation.

Remembering to take medication regularly can be a problem. Many people with epilepsy experience difficulty with their short-term memory. Using a dosette box can help. It may also be helpful to carry a daily dose of your medication with you in case you are not at home in time to take the next dose.

The traditional advice on missing a dose has often been to simply pass on it and not to try to catch up. That is not always a good idea. Leading Sydney neurologist Ernie Somerville supports the current view that you should take the missed dose as soon as you realise it was missed, even if this isn’t until the next dose is due. That is, you should catch up. The risk of this is minor overdosage, the symptoms of which are not serious and will last no more than a couple of hours, while the risk of not doing so is a seizure. Make sure you discuss this with your doctor. Better yet, make sure you don’t miss a dose. According to Dr Somerville some of the things you can do to remind yourself to take your medication is to make it part of your daily routine – take it with meals or take it when you get up and when you go to bed. To help you remember, you can keep your tablets on top of your pillow or in the kitchen. Some people use digital watch alarms to remind them. It is more important to take your medication at a time when you are more likely to remember than at exactly 12 hourly [or 8 hourly] intervals.

Other drugs

Withdrawal from sedative and hypnotic drugs including minor tranquillisers, sleeping pills and illegal drugs can be a problem, as can combining these drugs with antiepileptic medication. It is important to tell your doctor about all the medications you take. And this includes telling him or her about any over the counter herbal or vitamin supplements that you are taking or planning to take.

Legally prescribed drugs that may lower seizure threshold and some of the more commonly known interactions with over-the-counter products are discussed further on.

Other possible triggers

There are other possible triggers with some unique to certain people. For example some unusual stimuli which has been known to trigger seizures include the colour yellow, the smell of glue and sounds such as the telephone ringing or a siren.

Photosensitivity

Photosensitive epilepsy is rare affecting only a small number of people with epilepsy. With photosensitive epilepsy seizures are triggered by sensory stimuli such as flickering sunlight, strobe lights and flickering television. Simple preventative measures can be taken to decrease seizures triggered this way such as wearing wrap-around sunglasses to reduce glare and covering one eye to reduce the effects of flickering or flashing light. Most computer monitors do not present a problem, however if you are sensitive to screen flicker, try using a non-­interlaced monitor and take regular breaks.

Severe changes in temperature

In some people seizures may be triggered when the weather becomes very warm or rooms are overheated.

Stress

Stress is a normal part of life. In fact we need a certain amount to motivate ourselves and to stay healthy. Extreme stress, however, may lower your seizure threshold and trigger seizures. It is important to learn to recognise the signs and symptoms of harmful levels of stress and to employ strategies that you find helpful in reducing it. Relaxation techniques such as yoga, meditation, breathing exercises or aerobic exercise might be options worth trying.

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Last modified: September 04, 2006