Epilepsy is a neurological condition marked by recurrent, unprovoked seizures, affecting millions globally. Individuals with epilepsy are often prescribed anti-seizure medications (ASMs) to manage and reduce seizure frequency and severity. Despite consistent medication use, some individuals may still experience a seizure, which can be concerning for them and their caregivers.
What Defines a Breakthrough Seizure
A breakthrough seizure is an epileptic seizure occurring in an individual diagnosed with epilepsy who is regularly taking their prescribed anti-seizure medication as directed. This indicates the medication’s current regimen is not fully preventing seizure activity at that moment. It does not mean the medication has stopped working entirely, but rather that its protective effect was temporarily insufficient.
These seizures can vary in type and intensity, ranging from focal to generalized tonic-clonic events. Their occurrence signals that the existing treatment plan may need evaluation, underscoring the dynamic nature of epilepsy management where medication effectiveness can be influenced by various factors.
Factors Contributing to Breakthrough Seizures
Several factors can contribute to a breakthrough seizure, even with medication adherence. Medication-related issues include missing doses, inconsistent timing, or changes in the specific anti-seizure drug. Drug interactions with other prescribed medications, over-the-counter drugs, or herbal supplements can also alter ASM effectiveness.
Lifestyle factors significantly impact seizure control. Sleep deprivation is a known trigger for many individuals. High stress, acute illnesses like fever or infections, and alcohol or recreational drug use can lower an individual’s seizure threshold. For women, hormonal fluctuations associated with menstrual cycles, pregnancy, or menopause can sometimes trigger seizures (catamenial epilepsy). Breakthrough seizures may also signal a progression of the underlying epileptic condition or the development of new medical conditions that interact with seizure control.
Immediate Steps During a Breakthrough Seizure
If someone experiences a breakthrough seizure, focus on ensuring their safety and providing appropriate first aid. Remain calm and, if possible, note the seizure’s start and end times. The primary goal is to protect the individual from injury. Move any dangerous objects away and place something soft, like a jacket or cushion, under their head to prevent trauma.
Loosen any tight clothing around their neck to aid breathing. Never restrain the person or attempt to put anything into their mouth, as this can cause injury to both the individual and the helper. Stay with the person until the seizure ends and they are fully recovered and aware. Call emergency services if:
The seizure lasts longer than five minutes.
Repeated seizures occur.
The person is injured during the seizure.
It is their first seizure.
They have difficulty breathing after the seizure.
They do not regain consciousness.
Long-Term Management and Outlook
Experiencing a breakthrough seizure often necessitates a re-evaluation of the current epilepsy management plan. Contacting a healthcare provider, typically a neurologist specializing in epilepsy, is an important step after a breakthrough seizure. The doctor may consider various adjustments to the treatment strategy, which could include modifying the dosage, switching medications, or adding another drug.
Further diagnostic tests might be recommended to investigate potential underlying causes or changes in the brain’s activity. Maintaining a detailed seizure diary is highly beneficial for long-term management; this record should include seizure dates and times, potential triggers, and notes on medication adherence. Living with epilepsy involves ongoing management and regular follow-ups with healthcare professionals to ensure effective seizure control and to address any emerging concerns. Adherence to the prescribed treatment plan and open communication with the medical team are important for maintaining seizure control and improving quality of life.