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Epilepsy

Description

An in-depth report on the types, causes, diagnosis, and treatment of epilepsy.

Lifestyle Changes

The best preventive measure is to comply strictly with the drug regimen as prescribed. Seizures cannot be prevented by lifestyle changes alone, but people can make behavioral changes that improve their lives and give them a sense of control.

Avoiding Epileptic Triggers

In most cases, there is no known cause for epileptic seizures, but specific events or conditions may trigger them and should be avoided.

Inadequate or Fragmented Sleep. Inadequate or fragmented sleep can set off seizures in many people. In one study, the lowest risk for seizures was during REM sleep (when dreams occur). The highest risk was during light non-REM stages of sleep. Using sleep hygiene or other methods to improve sleep may be helpful.

Food Allergies. Food allergies may provoke seizures in children who also have migraine headaches, hyperactive behavior, and abdominal pains. Parents should consult an allergist if they suspect foods or additives might be playing a role in such cases.

Alcohol and Smoking. Alcohol and smoking should be avoided, although light alcohol consumption does not appear to increase seizure activity in people who are not alcoholics or sensitive to alcohol.

Flashing Lights. Patients should avoid exposure to flashing or strobe lights. Video games have been known to trigger seizures in people with existing epilepsy, but apparently only if they are already sensitive to flashing lights. Seizures have been reported in Japan among people who watched cartoons with rapidly fluctuating colors and quick flashes. The frequency of flashes per second is measured in hertz (Hz). Screens that emit a lower hertz (such as 50 Hz screens sold in Europe) are more likely to cause seizures in people with epilepsy than a higher-hertz screen (such as 100 Hz screens sold in the U.S.).

Relaxation Techniques

Relaxation methods include diaphragmatic rhythmic breathing, biofeedback, and meditation techniques. No strong evidence supports their value on reducing actual attacks (although some people have reported that they have), but they may be helpful in reducing anxiety in people who have positive experiences with them. There have been some reports that deep breathing (a common relaxation technique) triggers seizures in certain people.

Exercise

Exercise is important for many aspects of epilepsy, although it can be problematic. Weight-bearing exercise helps maintain bone density, which can be reduced by many of the medications, particularly the older ones. Exercise can also help to prevent weight gain, which is a problem with some drugs. There have been some reports that exercise may trigger seizures in some patients, but this is uncommon. A number of studies have found no significant association between physical activity and a higher incidence of seizures in patients with epilepsy. Nevertheless, if patients are concerned they should discuss this issue with their doctors.

Some small studies have reported significant benefits from the practice of yoga, which employs weight bearing and balancing postures. In one study, a system of meditation called Sahaja yoga changed EEG readings of brain waves and reduced seizures. Other studies report a 50% reduction in seizures and an overall decline in the number of attacks per month. Still, well-controlled studies are needed to confirm these benefits.

Dietary Measures

All patients should maintain a healthy diet, including plenty of whole grains, fresh vegetables, and fruits. In addition, dairy foods may be important to maintain calcium levels. Fasting has been used to prevent seizures since ancient times. In the 1920s, a high-fat, no-sugar, low protein diet, known as a ketogenic diet, was used to prevent seizures. It lost popularity after the introduction of anti-epileptic drugs but is now proving to be effective with many children. Researchers are investigating whether the Atkins diet (high protein, low carbohydrate) may help people with epilepsy. Both the ketogenic diet and the Atkins diet can interfere with some anti-epileptic medications such as topiramate. Talk to your doctor before beginning any special diet or a weight loss program.

The Ketogenic Diet The ketogenic diet, which is very high in fat (90%), very low in carbohydrates, and low in protein, has been studied and debated for decades. It has proven to be helpful for many children with severe epilepsy that does not respond to AEDs. It is not clear why it works. The standard theory is that burning fat instead of carbohydrates causes an increase in ketones. Excess ketones (called ketosis) appears to alter certain amino acids in the brain and to increase levels of the neurotransmitter gamma aminobutyric acid (GABA), which helps prevent nerve cells from over-firing. Some experts posit, however, that it is not ketones but the calorie restriction involved in the diet that provides its anti-seizure benefits. Benefits of the Ketogenic Diet. Studies report significant reductions in seizures in up to 85% of children who are good candidates for the program. A 2001 study was conducted on children 3 - 6 years after they had initiated the diet. In the study, 27% were with seizure free or had experienced more than a 90% reduction in seizures. About 40% were either off medication or down to one drug. Only 10% of the children were still on the diet. Many children also report significant improvements in attention and social functioning 1 year after starting the diet. Candidates of the Ketogenic Diet. The Ketogenic Diet seems to be most helpful for children in the following groups: Children ages 1 - 10 who suffer from Lennox-Gastaut syndrome Children who suffer from severe seizures associated with injury or birth defects Children with severe symptoms who do not respond to medications. Children younger than 12 have the best outcome, but some studies suggest the diet may be useful for motivated adults with severe epilepsy that does not respond to medication. Possibly safe and effective in some infants with uncontrolled seizures Most studies report benefits from the diet on patients with generalized seizures, but some patients with partial seizures may benefit from it. Typical Ketogenic Diet. (This diet must be professionally monitored! Parents can endanger their children if they try the program on their own without consulting a doctor or trained health expert.) The child fasts for the first 2 - 3 days, then the diet is gradually introduced. The regimen uses small amounts of carbohydrates and large amounts of fats (up to 90%), with very few proteins and no sugar. Children generally consume 75% of their usual daily calorie requirements. A typical dinner may include a chicken cutlet or piece of fish, broccoli with cheese, lettuce with mayonnaise, and a whipped cream sundae. Vegetables may include celery, cucumbers, or asparagus, cauliflower, and spinach. Breakfast might consist of an omelet, bacon, and cocoa with cream. (Artificial sweeteners are used for any desserts.) The diet is difficult, as a slight deviation from the diet can provoke a seizure. Children cannot take medications that contain sugar (which is common in many drugs produced for children). Some sunscreens and lotions contain sorbitol, which is a carbohydrate that can be absorbed through skin. Still, most children tolerate the diet if it reduces their seizures. In fact, between 50 - 75% of children are able to stay on it. Researchers are also investigating the Atkins diet, a popular weight-loss diet that has similar effects but is less restrictive than the ketogenic diet. Early results indicate that it might be helpful for some young people. Still, parents should not put their children on this diet without doctor support. Side Effects and Complications. To prevent serious side effects, children require regular monitoring by a doctor. Side effects or complications reported with the diet include: Kidney stones (the most severe common side effects, occurring in 6 - 10% of children on the diet). Patients should drink plenty of fluids. Oral citrate may be protective. Unhealthy cholesterol and lipid levels. The diet has been associated with very unhealthy changes in cholesterol levels and other lipids (fatty molecules). Since few children stay on the diet more than 2 years, such changes are unlikely to cause harm to the heart although long-term effects are still unknown. Some parents replace cream with heart-healthy olive or flaxseed oils and have found no increase in seizures in their children. Parents should be sure to consult with their doctor about any changes to the diet. Lethargy Nausea Diarrhea or constipation Dehydration Bone loss Recurrent infections Weight loss Bad body smell Behavioral and mental changes Rare but serious complications associated with the diet include pneumonia, severe infection, hepatitis, pancreatitis, and cardiomyopathy (injury to heart muscle).

Emotional and Psychologic Support

Many patients with epilepsy and parents whose children have epilepsy can benefit from support associations. These services are usually free and available in most cities.

Tips for Helping Children. Some of the following tips may help the child with epilepsy:

• Children should be treated as normally as possible by parents and siblings.
• Children should be assured that they will not die from epilepsy.
• Often children can be given the hope that they will outgrow the disorder.
• Most children will not have seizures triggered by sports or by any other ordinary activities that are enjoyable and healthy.
• As soon as they are old enough, children should be active participants in maintaining their drug regimens, which should be presented in as positive a light as possible.

Therapies for Children and Adults. Because of the risks for serious emotional consequences, psychological therapy may be beneficial and even necessary for some adults and children. In one study, cognitive behavioral therapy was helpful in lowering seizure rates in young people with juvenile myoclonic epilepsy. This approach offers a structured counseling program that helps people change behaviors that can reduce seizure risk factors such as anxiety and insomnia.

• Review Date: 11/15/2006
• Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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