It is often necessary to ask pointed questions to uncover seizure triggers, behaviors or environmental factors that may increase the possibility of a seizure. Common triggers include sleep deprivation, alcohol intake, stress, and other potentially modifiable factors. Measures to limit exposure to these triggers may successfully augment AED therapy.

For adolescents with juvenile idiopathic generalized epilepsies. Disturbances in their sleep–wake cycle, especially reduction of sleep, may provoke seizures the next morning. Following a regular sleep schedule is helpful; if possible, sleep onset should not vary by more than 2 hours. Sleep reduction, often combined with partying and substance abuse or stress, is a common precipitating factor in adolescents and adults with epilepsy. In some of these patients, regular sleep and a less stressful lifestyle may be enough to prevent further seizures. In addition, AEDs may not be able to achieve seizure control if the lifestyle is not changed.

In photosensitive patients, seizures are often precipitated by television. These can be avoided by viewing from a distance and using a remote control and by using small screens in a well-lit room. Environmental flicker stimulation often comes unexpectedly, and it is advisable that patients always wear sunglasses in brightly lighted surroundings. Polarized glasses seem to be more protective than plain sunglasses. If the patient has only photically induced seizures, specific prevention alone may be sufficient treatment, but when spontaneous seizures also occur, drugs are usually needed in addition. Some patients with partial seizures with an extended aura claim that they know how to prevent seizure spread with various nonspecific measures such as relaxation, concentration, or a combination of both.

Adapted from Elger CE, Schmidt D. Modern management of epilepsy. Epilepsy Behav 2008;12:501-39.

Reviewed By: 
Steven C. Schachter MD
Friday, May 9, 2008