What triggers seizures in Epilepsy?

Which circumstances can provoke Seizures?

This article is for patients with Epilepsy.

For factors which are severe enough to provoke seizures even in non-epileptic patients, read the following article below. Please note that this other article is essential to read even if you have Epilepsy – it is necessary for you to to avoid these provoking agents as well.

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Here is the list of circumstances (taken from the article above) which can precipitate seizures if you have Epilepsy.

Factors which can precipitate Seizures if you have Epilepsy

High fever (Children)
Lack of sleep
Stress
Menses
Missing your Anti-Epileptic dose

Let us talk about these factors in detail.

If my child has a Seizure when he has a high fever, does it mean that he/she has Epilepsy?

In the vast majority of cases: No, the child does not have Epilepsy.

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Children can have seizures when they have a fever.

Seizures which happen during a high fever are called “Febrile Seizures”. They usually occur in children.

  • In the vast majority of cases (>90%), Febrile Seizures do not indicate the onset of (or lead to the development of) Epilepsy.
  • Rarely, however, some Epilepsy syndromes which happen in Children may present initially with Febrile Seizures.
  • Some researchers multiple febrile seizures in childhood may slightly scar some brain parts, e.g. the “mesial temporal lobes”. This scarring may cause Epilepsy in adulthood. The risk of this happening is minimal, and many doctors believe it is almost zero.

If a child has pre-existing Epilepsy, then a high fever can precipitate a seizure. This is less common in Adults.

Does lack of sleep lead to Seizures?

Yes, definitely.

If you have Epilepsy, you should sleep for 8 hours a day. No excuses, no exceptions.

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Lack of sleep may precipitate seizures.

Lack of sleep is a very strong precipitant of Seizures in certain Epilepsy Syndromes, especially Juvenile Myoclonic Epilepsy (JME). If patients with JME don’t sleep well, they get many jerks of the body in the morning. If they are lucky, that is all that happens. Unfortunately, sometimes they also get a whole body generalized seizure.

Lack of sleep can precipitate all kinds of Seizures.

Video-EEG monitoring is an unusual situation when the patient is admitted to the hospital, hooked up to the EEG, and everyone is waiting for a seizure to happen so that it can be studied. If seizures don’t occur by the third day, guess what the doctor and patient conspire to do: Sleep deprivation! The patient sleeps for only 4 hours in the night. Sure enough, many of these patients have a seizure the next day, regardless of their Epilepsy Syndrome.

Does alcohol precipitate seizures?

Excessive intake of alcohol can precipitate seizures in a person with Epilepsy.

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Excessive intake of alcohol may precipitate seizures.

Some people who drink huge quantities of alcohol may get seizures, even if they dont have Epilepsy.

Does Stress precipitate Seizures?

Yes, it seems to.

25% of patients with Epilepsy report that Stress precipitates their seizures (Nakken et al. 2005). No one quite understands why this happens; some people believe that hormonal imbalances may play a role.

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Stress may precipitate both Epileptic seizures & Non-Epileptic attacks.

Note: Here we are talking about stress precipitating seizures in Epilepsy, due to an increased abnormal tendency of the Brain to have seizures. But, stress can cause seizure-like attacks even when the Brain has NO tendency to have seizures – These are called “Psychogenic Non-Epileptic Seizure-like-attacks” or PNES, described in another article (click here). It is very important to find out if you have Epilepsy worsened by stress OR if you have PNES – both are real problems with good solutions, but the treatments are different.

Considering that 1/4th of patients report a worsening of seizures when they are stressed out, learning stress reduction & relaxation techniques would be an excellent idea.

Certain people may be more susceptible to depression and anxiety at certain times of the year. Some people may need a counsellor or psychiatrist to sort out these issues. You can read more about depression and anxiety and methods to reduce them here:

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Can Menses precipitate Seizures? What are “Catamenial Seizures”?

Yes.

Some, but not all women, may complain of worsening of seizures around their menses. This worsening is due to the high levels of a hormone called “Estrogen” in the body. These seizures are called “Catamenial Seizures”.

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Some women report that they have seizures around menses.

If a lady with Epilepsy is started on anti-epileptics and stops having all seizures, the seizures around Menses may also stop.

In some cases, all seizures except those around Menses may stop. These women may need a slight increase in the dosage of their anti-epileptics during these times, for additional protection. Your doctor may use medications called Benzodiazepines (for example, Clobazam) to provide this extra protection.

In some of these patients, increasing the anti-epileptic dose may not help either. If traditional anti-epileptics don’t work, certain other medications including Acetazolamide or in rare cases a hormone called “Progesterone” may be helpful.

Can missing your Anti-Epileptic medication precipitate Seizures?

Well… Yes, of course.

I think there are two main reasons for not taking medications on time.

1. Many people don’t like taking their anti-epileptic medications.

A lot of people initially have trouble accepting the diagnosis of Epilepsy. This is understandable. It is a somewhat difficult disorder to understand, and the apprehension and complexity of treatments can be overwhelming. This is one of the reasons I wrote this guide. One of the ways we can learn to accept the diagnosis is to increase our knowledge about the disease.

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Some patients hate their medications!

Once we accept the diagnosis, the resentment or apprehension while taking Anti-Epileptic medications disappears.

2. Some people forget to take their medications on time.

Please allow me to give you a few tips that I have found helpful with my patients:

  • Take medications at the same time every day: e.g. 9 AM and 9 PM.
  • Use your smartphone to set reminders for this time.
  • OR take your medication immediately after something you do twice every day – e.g. brushing your teeth. Take medicines as the very first thing you do after completing the automatic activity – keep your medications above your washbasin.
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    If you brush twice daily, take your pills immediately after you finish brushing.
  • Use a pill-box. Nowadays, you can buy an electronic pill-box which beeps when it’s time to take your medications.
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    Using a simple pill box is very helpful. Nowadays, you can even buy pill-boxes with inbuilt alarms!
  • Count your pills at the beginning of the month, and count them again at the end. The difference should be approximately 30 (or 60) tablets.
Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

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