Why Seizures Still Occur on Medication
Breakthrough seizures can be discouraging, especially for individuals who have experienced long periods of seizure freedom. Understanding the various reasons they can happen is the first step toward effective management. These causes range from issues directly related to the medication to underlying conditions or lifestyle factors.
Medication-Related Factors
- Non-Adherence to Medication: This is one of the most common reasons for a breakthrough seizure. Missing a dose, taking medication at inconsistent times, or running out of a prescription can cause the drug levels in your body to drop below the necessary therapeutic range. Even taking the medicine a few hours later than usual can be enough to reduce its effectiveness.
- Inadequate Dosage: The optimal dose of an antiseizure medication (ASM) can change over a person's lifetime due to physiological changes from puberty, aging, or weight gain or loss. What was once an effective dose may no longer be sufficient to prevent seizures. Additionally, some individuals may have a faster metabolism that causes drugs to clear their system more quickly, requiring a higher dose.
- Drug-Drug Interactions: A wide variety of substances, including other prescription medications, over-the-counter drugs, herbal supplements, and foods, can interfere with how ASMs work. For instance, certain antibiotics can decrease the effectiveness of some ASMs, while grapefruit can also alter a drug's metabolism. Always inform your healthcare provider of any new medications or supplements you begin taking.
- Switching Generic Brands: While generic and brand-name medications have the same active ingredients, the inactive ingredients may differ slightly. In some sensitive individuals, this minor change can alter the drug's absorption and lead to a loss of seizure control. If you notice a change after switching generics, you should speak with your doctor.
Non-Medication Triggers
In addition to medication factors, many seizures are precipitated by lifestyle and environmental triggers, even when medication levels are stable.
- Sleep Deprivation: Not getting enough quality sleep is a well-known trigger for seizures for many people with epilepsy. Regular, consistent sleep is a critical part of a seizure management plan.
- Stress and Anxiety: High levels of psychological stress or emotional anxiety can lower the seizure threshold. Developing and practicing stress management techniques can be an important component of managing epilepsy.
- Illness and Fever: Infections, especially those accompanied by fever, are a common trigger for breakthrough seizures in both children and adults. The body's inflammatory response to the illness can disrupt the brain's electrical stability.
- Alcohol and Drug Use: Both alcohol consumption and alcohol withdrawal can trigger seizures. Excessive caffeine and recreational drug use can also lower the seizure threshold and interfere with ASM effectiveness.
- Hormonal Changes: Many women with epilepsy experience catamenial epilepsy, where seizures become more frequent around their menstrual cycle due to fluctuating hormone levels.
Drug-Resistant Epilepsy
Also known as refractory or intractable epilepsy, this condition affects around one-third of people with epilepsy, for whom seizures are not controlled despite trials of at least two appropriate ASMs. In these cases, the underlying biology of the epilepsy may be resistant to the mechanisms of standard medications, or the person may have an autoimmune component contributing to their seizures. The Epilepsy Foundation provides comprehensive information about this condition and alternative treatments for drug-resistant epilepsy.
Comparison of Common Breakthrough Seizure Causes
| Cause | Example | Management Strategy |
|---|---|---|
| Medication Non-Adherence | Forgetting to take a dose due to a change in routine. | Use pill boxes, set alarms, or link medication with a daily activity like brushing teeth. |
| Lifestyle Triggers | A late night out leads to sleep deprivation and a subsequent seizure. | Implement consistent sleep hygiene, manage stress, and identify personal triggers. |
| Drug Interactions | Starting a new antibiotic that interferes with the ASM's absorption. | Inform all doctors and pharmacists about every medication, supplement, or herbal remedy you take. |
| Inadequate Dosage | A child undergoing a growth spurt who requires a higher medication dose. | Work closely with a neurologist to monitor seizure control and adjust dosage as needed. |
| Underlying Illness | A fever from an infection triggers a seizure. | Seek prompt medical attention for illness and notify your neurologist. |
| Drug-Resistant Epilepsy | Seizures continue despite being on optimal doses of multiple ASMs. | A comprehensive evaluation may be needed to explore non-pharmacological treatments like surgery or neurostimulation. |
What to Do After a Breakthrough Seizure
After a breakthrough seizure, it is crucial to re-evaluate your treatment and lifestyle with your neurologist. Here's a summary of steps to take:
- Log the Seizure: Keep a seizure diary to record the date, time, and potential triggers. This information is vital for your doctor.
- Contact Your Neurologist: Your doctor can help you determine the cause and decide if a medication adjustment is necessary. They may also check your ASM blood levels.
- Assess Adherence: Be honest with yourself and your doctor about your medication habits. If you have been missing doses, this is likely the cause and can be corrected with reminders.
- Manage Lifestyle Factors: Prioritize sleep, practice stress-reducing techniques like meditation or exercise, and be mindful of alcohol and other drug intake.
- Explore Other Options: If medication is no longer effective, your neurologist might suggest a different drug, a combination of medications, or alternative therapies for treatment-resistant cases.
The Outlook for Managing Breakthrough Seizures
Experiencing a breakthrough seizure doesn't necessarily mean that your epilepsy is no longer controllable or that your medication has failed permanently. For many, it's a temporary setback caused by an identifiable trigger, and control can often be regained by addressing the root cause. For those with drug-resistant epilepsy, while seizure freedom may not be achievable through standard medication, other options can significantly reduce seizure frequency and improve quality of life. A collaborative, open discussion with your healthcare team is the best way forward.
Conclusion
While antiseizure medications are highly effective for many, it is possible and not uncommon to still have seizures. Factors ranging from lifestyle influences and medication inconsistencies to the presence of drug-resistant epilepsy can cause these breakthrough seizures. The key to managing this is careful monitoring, open communication with your healthcare provider, and a systematic approach to identifying and addressing potential triggers. By working with your medical team, you can take control of your treatment and improve your quality of life.
