A breakthrough seizure is an epileptic seizure that occurs in an individual who is already receiving anti-seizure medication and whose seizures were previously controlled. These events can be concerning for individuals managing epilepsy, as they indicate a temporary loss of seizure control despite ongoing treatment. Understanding the various reasons why these seizures may occur is important for both individuals and their healthcare providers in effectively managing the condition. This knowledge can help in identifying potential triggers and adjusting treatment strategies to maintain seizure freedom.
Medication Adherence
The most frequent reason for a breakthrough seizure is often related to how consistently anti-seizure medications are taken. Forgetting to take a dose, taking medication at irregular times, or running out of a prescription can disrupt the steady level of the drug in the body. Maintaining a consistent concentration of anti-seizure medication in the bloodstream is crucial for its effectiveness in preventing seizures.
Even small deviations from the prescribed schedule can lead to a drop in medication levels below the therapeutic range required to suppress seizure activity. This makes the brain more susceptible to electrical disturbances that result in a seizure. Missing doses can increase the risk of more intense seizures, seizure clusters, or even status epilepticus. Following the exact instructions provided by a healthcare professional regarding dosage and timing is fundamental to maintaining seizure control.
Other Medical and Physiological Influences
Various medical and physiological factors can also contribute to breakthrough seizures, even when medication adherence is optimal. Acute illnesses, such as infections accompanied by fever, can lower an individual’s seizure threshold, making them more vulnerable to a seizure. The body’s response to infection can decrease the brain’s resistance to seizure activity, particularly in children.
Interactions with other medications are another common cause; some prescription drugs or over-the-counter remedies can reduce the effectiveness of anti-seizure medications. For instance, certain antibiotics, antidepressants, antihistamines, or even some herbal supplements can interfere with the metabolism or absorption of anti-seizure drugs, leading to lower therapeutic levels. Adjustments to medication dosage or switching to a different anti-seizure medication without close medical supervision can also destabilize seizure control. Hormonal fluctuations, particularly in women, can influence seizure activity; changes during menstrual cycles, pregnancy, or menopause can alter seizure thresholds in some individuals.
Lifestyle and Environmental Factors
Beyond medical conditions, daily lifestyle choices and environmental exposures can also play a role in the occurrence of breakthrough seizures. Insufficient sleep is a well-recognized trigger, as prolonged sleep deprivation can significantly lower the seizure threshold in many individuals. This is because sleep influences the brain’s electrical and hormonal activity. Maintaining a regular sleep schedule and ensuring adequate rest is often recommended for those with epilepsy.
High levels of emotional or physical stress can also increase the likelihood of a breakthrough seizure. While stress does not directly cause epilepsy, it can exacerbate seizure frequency in some people by altering brain chemistry and electrical activity. Alcohol consumption, especially heavy drinking or withdrawal, is another trigger, as it can provoke seizures, disrupt sleep, and reduce medication effectiveness. Recreational drug use can similarly provoke seizures. Severe nutritional imbalances and dehydration can contribute to a lowered seizure threshold by affecting electrolyte balance and neuronal excitability.
When to Seek Medical Advice
If you experience a breakthrough seizure, it is important to contact your healthcare provider promptly. Any new seizure, an increase in how often seizures occur, or a change in their severity warrants a medical evaluation. Medical advice is also important if you notice new or worsening medication side effects, or have concerns about adherence or drug interactions. Your doctor can investigate the specific cause, reviewing your medication, checking for illnesses, or discussing lifestyle.
It is important to avoid making any changes to your anti-seizure medication or lifestyle based on self-diagnosis. A healthcare professional can thoroughly investigate the underlying reasons for the breakthrough seizure and make appropriate adjustments to your treatment plan, which may involve dose adjustments, switching medications, or exploring strategies to improve adherence.