From the Guidelines
Seizure triggers should be identified and managed through lifestyle modifications and consistent medication adherence to reduce seizure frequency and severity. According to the latest clinical policy approved by the ACEP board of directors in 2024 1, seizure management can be clinically challenging, and noncompliance with antiseizure drug therapy may make patients more likely to present to the ED with seizure. Common triggers include:
- Lack of sleep
- Stress
- Alcohol consumption
- Missed medication doses
- Flashing lights or patterns (photosensitivity)
- Fever or illness
- Hormonal changes during menstruation
- Certain medications, such as tramadol and illicit substances like cocaine, which can lower the seizure threshold 1 Identifying personal triggers is essential through keeping a seizure diary that tracks activities, foods, sleep patterns, and stress levels before seizures occur. Management strategies include:
- Maintaining regular sleep schedules (7-9 hours nightly)
- Developing stress reduction techniques like meditation or deep breathing
- Limiting alcohol consumption
- Taking anti-seizure medications consistently as prescribed
- Avoiding known visual triggers
- Promptly treating fevers with appropriate medications like acetaminophen or ibuprofen Understanding these triggers helps patients gain better control over their condition by making lifestyle modifications that reduce seizure frequency and severity. Additionally, women experiencing catamenial epilepsy (seizures related to menstrual cycles) may benefit from hormonal therapies. By prioritizing trigger identification and management, patients can reduce their risk of seizures and improve their overall quality of life.
From the Research
Seizure Triggers
- Seizure triggers can be complex and multifaceted, involving various factors such as sleep patterns, medication, and underlying medical conditions 2
- Sleep duration, sleep deprivation, and the sleep-wake cycle are thought to play an important role in the generation of epileptic activity and may also influence seizure risk 2
- A study found that day-to-day changes in sleep duration had a minimal effect on reported seizures, while patient-specific changes in bed and wake times were more important for identifying seizure risk the following day 2
- Nocturnal seizures were associated with both significantly longer sleep durations and increased risk of a seizure occurring in the following 48 h 2
Medication and Seizure Control
- Levetiracetam (LEV) and Carbamazepine (CBZ) are two commonly used antiepileptic drugs for the treatment of partial seizures and poststroke seizures 3, 4
- A study comparing LEV and CBZ as monotherapy in partial epilepsy found similar efficacy and safety profiles, with LEV showing better quality of life compared to CBZ 3
- Another study found that LEV may be a valid alternative to CBZ in poststroke seizures, particularly in terms of efficacy and safety, with significant advantages over CBZ on cognitive functions 4
Current Role of Antiepileptic Drugs
- The role of CBZ and OXC in the management of epilepsy has evolved with the introduction of newer antiepileptic drugs, but they remain important options for the treatment of focal-onset epilepsy and primary generalized tonic-clonic seizures 5
- CBZ remains among the most prescribed drugs for focal epilepsy in many countries, representing a good compromise between cost, availability, and effectiveness 5
- OXC is among the first-choice options for the initial treatment of focal-onset seizures in several countries, including the US and China 5