Introduction

Triggers are situations or events that may possibly lead to a seizure. Some epileptic patients experience seizures triggered by certain activities while others will have no seizure triggers at all.¹

What is epilepsy?

Epilepsy is a brain disorder in which neurons send the wrong signals for brain activity which leads to seizures. A seizure is a sudden and uncontrolled change in chemical and electrical activity of the brain that leads to alteration in an individual’s behaviour, movement, level of awareness and/or feelings. Some might experience seizures without being diagnosed with epilepsy whereas others will.^2,3

Types of seizures

Seizures can be classified into two main broad categories: focal seizures and generalized seizures.

Focal seizures

This type of seizure emerges from one part of the brain. Majority of the epileptic patients experience focal seizures. The consciousness of the individual remains intact.

Generalized seizures

This type emerges on both sides of the brain. The individual may lose consciousness.

They are further classified into the following categories:

• Absence seizures 
• Tonic seizures 
• Clonic seizures 
• Myoclonic seizures 
• Atonic seizures 
• Tonic-clonic seizures
• Secondary generalized seizures⁴

This article throws light on the contributing factors that may result in a seizure (also called seizure triggers) and helps identify when a seizure may be coming. Identifying the triggers may help in managing seizures with their occurrence, risks and safety. 

Lifestyle-related triggers

Alcohol

Avoid drinking alcohol in large quantities or over long periods of time. Alcohol does not trigger seizures when the person is drinking. However, withdrawal symptoms do trigger seizures. These symptoms are reported to occur 6 to 72 hours after one has stopped drinking alcohol.

Withdrawal seizures are common among people who have alcohol use disorder.

According to research, adults with epilepsy may have one or two alcoholic drinks a day without triggering their seizures or altering the blood levels of their seizure medications.

Drug abuse

The effects and risks of some drugs may vary greatly. They may affect the electrical activities of the brain and seizures and interact with other seizure medications. Nicotine, cocaine, cannabis, heroin, amphetamines and caffeine may provoke seizures and hence should be taken under medical supervision if needed.

Sleep deprivation

Lack of good sleep makes people prone to seizures. It can even intensify and lengthen the duration of seizures. It is crucial to get enough good quality sleep to keep seizures at bay. Steps should be taken to improve sleep (mainly a good diet and regular exercise) if need be.

Nutritional deficiencies

In general, vitamins and minerals are essential nutrients for normal and balanced functioning of the body.  The only vitamin deficiency known to cause or trigger seizures is a deficiency of vitamin B6 (pyridoxine). Low levels of sodium, calcium and magnesium can also alter the electrical activity of the brain cells and can cause seizures. The healthcare provider may prescribe extra doses of the deficient minerals if the blood concentrations are low in any epileptic patient.

Stress

Stress comes in different forms and has a variable impact on individuals. Stress leads to unwanted worries, depression, frustration and sometimes even anger. It is still unclear how stress triggers a seizure. However, it is always recommended to find ways to combat stress and indulge in stress-busting activities to stay away from any disease or illness in general.

Health-related triggers

Menstruation

Approximately half the women experience an increase in seizures at the time of their monthly menstrual cycle. Changes in seizures are often observed during ovulation and around a week before menstrual bleeding.

It is recommended that women keep track of their menstrual cycle and take utmost care of their health during that time. Adjusting the dose and changing seizure medicines can only be done by consulting the healthcare provider.

Missed medications

Missing medications can provoke seizures. The likelihood of occurrence is even higher if the patient has to take a single dose in a day and he/she misses that dose as a full day of medication has been missed. If one has been prescribed two to four times, then the risk from missing one dose is less. However, missing several doses in a row can lead to severe seizures. It is dangerous to stop taking medications without consulting the doctor. Steps should be taken to improve or increase medication adherence for epileptic patients or for those who are experiencing seizures.

Other illnesses

Some types of acute illness or infection may trigger seizures in epileptic patients. Lung infections, sinus infections colds or any infection caused by viruses or bacteria can lead to changes in seizures. It can be triggered by the stress of being sick, fever and/or dehydration.

It is advisable to observe and note down the medications that provoke seizures and discuss it with the healthcare provider. It is recommended to take the full course of medications and to not miss any dose without consulting the healthcare provider.

Over-the-counter (OTC) medications

A few medicines that one can get without a prescription can provoke seizures in epileptic patients. The common OTC medications include those which are used for colds, allergies and promoting sleep or herbal medicines. It is best to read the labels and consult healthcare providers before taking any OTC medication.

Sensory triggers

Photosensitivity

Exposure to flashing lights of variable intensities or visual patterns can trigger seizures. It is more commonly observed in children and adolescents and is known to become less frequent with age.

Many individuals are not aware of their sensitivity to light till they experience a seizure. Many other individuals who are sensitive to light do not have seizures but have other symptoms like headache, nausea and dizziness. They might not have epilepsy.⁵

Managing triggers

Maintaining a seizure diary

By keeping track of potential activities that may aggravate seizures and by observing the patterns, frequent occurrence of seizures can be prevented.

Consulting healthcare provider

By paying regular visits to healthcare providers and consulting them may help them identify an individual-specific trigger and prescribe medications accordingly.

Lifestyle changes

This mainly focuses on managing stress, building quality sleep habits, exercising regularly and consuming a balanced diet.

Patient education

It is helpful if the patients are made aware of the potential triggers that may provoke seizures and are given knowledge of the interventions that can be carried out in order to prevent further complications.^1,3,5

Summary

The activities that have the potential to cause a seizure are called seizure triggers. These triggers can be experienced in patients with epilepsy and also in patients who only have seizures. Identifying the causes that provoke seizures is crucial in order to treat them or prevent them. It is recommended to consult the concerned healthcare providers who can help in identifying as well as combating seizure triggers. It is advisable to exercise regularly, keep good eating habits, maintain a good quality sleep and manage stress so as to keep seizures at bay.