UNDERSTANDING EPILEPSY
Seizure trigger factors
Some people find that certain factors may trigger or provoke seizures. You may not become aware of your trigger factors unless you keep a seizure diary for a period of time. Some of the more common triger factors include:
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 no more than two standard drinks a day for women and no more than four standard drinks a day for men. A standard drink is equal to:
- one small glass of wine (100ml)
- one glass 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
Some people are susceptible to 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.
For some people, caffeine is a trigger so drinks containing caffeine, such as coffee, tea and those with cola, should be avoided. Caffeine may trigger seizures if it is consumed to excess and leads to sleep deprivation.
Infections and illness
Children are particularly likely to have more seizures when they develop infections such as tonsillitis and ear-ache. This is possibly due to a high temperature and usually eases within a few days.
Allergies may provoke seizures in some people with epilepsy. Diarrhea 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 very common trigger factor. Everyone differs in the amount of sleep they need, however, avoid staying awake all night and wild fluctuations in the time you go to bed. Make sure you get enough sleep to feel rested. If possible, avoid staying up late if you need to get up very early the next morning.
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 prone to having 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 can be life-threatening and almost certainly will require hospitalisation.
Remembering to take medication regularly can be a problem. Using a dosette box or Webster pack can help as can carrying 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 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.
The risk of this is minor over-dosage, 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 are to make it part of your daily routine - take it with meals or 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. 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 elsewhere in this website.
Photosensitivity
The tendency for seizures to be triggered by seeing flicker or patterns is known as photosensitivity. Only about 5 percent of people with epilepsy are photosensitive.
Flicker frequency is usually measured in flashes per second or Hertz 9Hz. The frequencies most associated with seizures are 10Hz to 25Hz, however, faster and slower frequencies can occasionally be a problem for some people.
Fine patterns can also cause photosensitive seizures, particularly stripes and checks, or the combination of pattern and flicker. The most common combination would be sunlight through trees as seen from a moving car. Escalators and occasionally fly-screens can also be an issue for some people. Brighter lights and patterns with great contrast are more likely to produce photosensitive seizures than those that are dim or faint. In addition, the more of the field of vision taken up by the pattern or flickering light, the more likely it is that a seizure will be triggered. While sunlight can be difficult to avoid, wrap-around polarised sunglasses can help.
Television has traditionally been the commonest cause for photosensitive seizures due to how the picture is produced. Television screens are divided into hundreds of vertical lines known as the raster. Although in standard definition broadcasts the screen is said to refresh at 50Hz (50 times per second), in fact only every second line is changed each time. This produces a 25Hz flicker when viewed up close and is within the range of frequencies that is commonly a problem.
Console games, usually played via a television screen, have the same problems. Computer screens do not have a raster and usually refresh at 60Hz or more, therefore, they do not flicker at the critical frequency. Although computers, particularly when playing games, are not without risk, the absence of hardware-related flicker makes them less of a problem than television.
Sitting at least two metres from the television will make the raster invisible, thus reducing the risk of triggering a seizure. When presented with flicker that is uncomfortable, looking away or covering one eye is most useful. Closing both eyes can worsen the situation, particularly with very bright lights, and may ensure a seizure occurs.
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 walking, yoga, breathing exercises or aerobic exercise might be options worth trying.
Other possible triggers
There are other possible triggers with some unique to certain people. For example, some unusual stimuli, which have been known to trigger seizures, include the colour yellow, the smell of glue and sounds such as the telephone ringing or a siren.
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