What are common triggers for seizures in individuals with epilepsy?

Common Triggers for Seizures in Epilepsy

Stress, sleep deprivation, and psychological factors are the most common triggers for seizures in individuals with epilepsy, with stress being reported in up to 65.8% of triggered seizures. 1

Primary Seizure Triggers

Based on current evidence, the following are the most common seizure triggers in epilepsy:

Psychological Triggers

• Stress: The most frequently reported trigger, identified in approximately 65.8% of seizures where triggers were reported 1
• Anxiety and emotional distress
• Mental fatigue

Physiological Triggers

• Sleep deprivation: Reported in 30.5% of triggered seizures 1
• Hormonal changes: Particularly menstrual cycle in women (19.7% of triggered seizures) 1
• Physical overexertion: Reported in 18% of triggered seizures 1
• Fever: Particularly significant in children with febrile seizures 2

Environmental and Lifestyle Triggers

• Flashing lights: A trigger in reflex epilepsy 2
• Alcohol consumption
• Medication non-adherence: Sudden withdrawal of antiepileptic drugs can trigger seizures 3

Multiple Trigger Phenomenon

Many individuals with epilepsy report combinations of triggers rather than isolated factors. Common combinations include:

• Stress with lack of sleep
• Stress with overexertion
• Stress with hormonal changes (menstruation) 1

Clinical Implications

Patients who report seizure triggers are more likely to be on multiple anti-seizure medications (3 or more), suggesting potentially more difficult-to-control epilepsy 1. This highlights the importance of trigger identification and management as part of comprehensive epilepsy care.

Trigger Management Strategies

1. Stress reduction techniques:

   • Psychotherapy can help patients manage stress that may increase seizure frequency 2
   • Education about the benign nature of certain epilepsy types can reduce psychological stress 2

2. Sleep hygiene:

   • Maintain regular sleep schedule
   • Avoid sleep deprivation

3. Medication adherence:

   • Antiepileptic drugs should be withdrawn gradually to minimize the potential of increased seizure frequency 3
   • Consistent medication timing

4. Trigger avoidance:

   • For those with reflex epilepsy, avoiding specific triggers like flashing lights 2

Important Considerations

Seizure Awareness

Many patients (up to 55.5%) may be unaware of their seizures, particularly complex partial and secondarily generalized tonic-clonic seizures 4. This can lead to underreporting of seizure frequency and triggers, potentially affecting treatment decisions.

First Aid for Seizures

For caregivers and family members, understanding proper seizure first aid is essential:

• Help the person to the ground and place them on their side in recovery position
• Clear the area around them to prevent injury
• Stay with the person having a seizure
• Do not restrain the person or put anything in their mouth 2

When to Seek Emergency Care

Emergency medical services should be activated for:

• First-time seizures
• Seizures lasting >5 minutes
• Multiple seizures without return to baseline mental status
• Seizures with traumatic injuries or difficulty breathing
• Seizures in infants <6 months or pregnant individuals 2

Conclusion

Identifying and managing seizure triggers is a crucial component of epilepsy care. While stress and sleep deprivation are the most commonly reported triggers, individual trigger patterns vary significantly. Patients should be encouraged to maintain detailed seizure diaries that include potential triggers to help optimize their treatment plan and improve quality of life.