Epilepsy is a neurological condition characterized by recurrent, unprovoked seizures, which are temporary disturbances in the brain’s electrical activity. Management typically involves the long-term use of anti-epileptic drugs (AEDs) to achieve and maintain complete seizure control. A consistent medication regimen often leads to extended periods of seizure freedom, allowing individuals to manage their daily lives effectively. However, even under optimal control, a seizure can still happen unexpectedly.
What Defines a Breakthrough Seizure
A breakthrough seizure is an episode that occurs in an individual whose epilepsy has been stabilized and well-controlled by medication for a significant duration. This period of seizure freedom is commonly defined as at least 12 months without an event while adhering to a prescribed anti-epileptic drug regimen. The occurrence of a breakthrough seizure represents a sudden, unpredicted failure of the current treatment plan.
This type of seizure is distinct from those that happen during the initial diagnostic phase or when a person is actively trialing medications to find an effective dose. A breakthrough seizure signals a change in the established equilibrium between the brain’s seizure threshold and the protective effect of the medication. Approximately one-third of individuals who achieve seizure freedom may experience a breakthrough event at some point. The recurrence often indicates that the concentration of the protective medication in the bloodstream has dropped below the necessary therapeutic level.
Common Triggers and Contributing Factors
The most frequently identified cause of a breakthrough seizure involves issues with medication adherence, such as missing a dose or taking it significantly later than scheduled. This inconsistency causes the anti-epileptic drug level in the body to fluctuate, momentarily reducing its protective effect. Failure to take the medication as prescribed is cited as the reason for over half of all breakthrough events in some studies.
Lifestyle factors also play a substantial role in lowering the seizure threshold, making a breakthrough more likely. Severe sleep deprivation and high levels of psychological stress are major triggers. These conditions alter brain activity and can make the central nervous system more susceptible to the electrical disturbances that cause seizures.
Physiological changes within the body can similarly contribute to a lapse in control. An acute illness or infection, especially one accompanied by a high fever, is a common trigger. Hormonal fluctuations, such as those occurring during the menstrual cycle in women, can also influence seizure activity.
The introduction of new medications or supplements may also unintentionally reduce the efficacy of the established AED regimen. Certain drugs can interact with anti-epileptic medications, causing the body to metabolize the seizure medication too quickly. This drug-drug interaction results in a lower-than-intended concentration of the protective medication in the blood.
Next Steps: When to Contact a Doctor and Immediate Safety
Immediate safety during a seizure focuses on protecting the person from injury until the episode concludes naturally. If a convulsive seizure occurs, gently ease the person to the floor and turn them onto their side to help keep the airway clear. Clear the immediate area of any hard or sharp objects, and place something soft under the person’s head for cushioning.
Time the event from start to finish, but avoid restraining the person or placing anything in their mouth. Most seizures end spontaneously within a few minutes, after which the individual may be confused or tired. They should be allowed to rest and recover in a safe environment.
A medical review with a neurologist is necessary following a breakthrough seizure to determine the cause and potentially adjust the treatment plan. Contact emergency services immediately if the seizure lasts longer than five minutes or if a second seizure begins shortly after the first without the person regaining consciousness. Immediate help is also needed if the person has difficulty breathing after the movements stop or sustains a significant injury during the event.
Recurring breakthrough seizures indicate a need to re-evaluate the treatment strategy. This may involve checking drug levels in the blood, adjusting the current dosage, or considering a change in anti-epileptic medication. Detailed information gathered about the episode, including potential triggers and the seizure’s duration, will guide the doctor in making necessary adjustments to re-establish long-term seizure control.