Even with a consistent medication schedule, experiencing a seizure remains a possibility for individuals managing epilepsy. This phenomenon, often termed a “breakthrough seizure,” occurs despite adherence to a regular treatment plan. Anti-Epileptic Drugs (AEDs) are the primary treatment for epilepsy, a chronic neurological condition characterized by recurrent seizures. While these medications stabilize electrical activity in the brain, they do not offer an absolute guarantee of seizure freedom for every person.
Defining Seizure Control While on Medication
The fundamental goal of using anti-seizure medication is to achieve “optimal therapy,” meaning the best possible seizure control with the fewest side effects. For most people, this means a significant reduction in the frequency and severity of seizures, often leading to complete seizure freedom. AEDs function by raising the seizure threshold in the brain, making nerve cells less prone to the excessive electrical discharges that cause a seizure. These drugs work by altering the flow of ions or affecting neurotransmitters that regulate brain activity. About 60 to 70 percent of people achieve full seizure remission, but for the remaining individuals, treatment aims to minimize the condition’s impact.
Pharmacological Causes of Breakthrough Seizures
A drop in medication concentration in the bloodstream is a primary reason seizures occur while on treatment, often resulting from poor adherence, such as missing a dose, which lowers the brain’s seizure threshold. Drug-drug interactions are another significant pharmacological issue, where other medications interfere with the body’s processing of the AED. Certain supplements or drugs can increase the breakdown or reduce the absorption of the anti-seizure medication, lowering its protective concentration. Additionally, a patient’s metabolism may change over time, causing liver enzymes to process the AED too quickly, leading to sub-therapeutic levels. Drug resistance is also a factor, occurring when the specific drug formulation is no longer effective for the individual’s seizure type.
External Triggers That Reduce Medication Effectiveness
Factors outside of the medication can override the protective effect of anti-seizure drugs, even at stable therapeutic levels. Primary external triggers include sleep deprivation and high levels of emotional or physical stress, both of which destabilize brain activity. Acute illnesses, particularly those involving a fever or infection, can also provoke a seizure by lowering the seizure threshold. Furthermore, the consumption of alcohol or recreational substances can directly affect brain chemistry and interact with the AED, increasing seizure susceptibility. For women, hormonal fluctuations during the menstrual cycle, known as catamenial seizures, act as a physiological trigger. Identifying and managing these personal triggers is a crucial part of living with epilepsy.
Immediate Steps Following a Breakthrough Seizure
Following a breakthrough seizure, the immediate step is to ensure the person’s safety and provide basic first aid. After the seizure movements stop, gently turn the person onto their side and remove any nearby objects that could cause injury as they recover. Note the exact time the seizure began and ended, as a seizure lasting longer than five minutes requires emergency medical attention. Once the person is fully alert, check the circumstances for potential causes, reviewing medication logs for missed doses and documenting the seizure’s characteristics and triggers. Promptly contacting the prescribing neurologist or care team is necessary, as a breakthrough seizure indicates a need for a treatment plan review and potential adjustment to the medication dosage or regimen.