An epileptic seizure that occurs despite antiepileptic drugs that had previously prevented seizures is called a breakthrough seizure. Breakthrough seizures can increase morbidity, mortality, and economic burden. Their causes include insufficient dosing, missed doses, provoking factors like stress or drugs, or ongoing epileptic processes. Management involves identifying the etiology, adjusting antiepileptic drug treatment, using newer drugs, and treating the underlying seizures.

1. Ade Wijaya, MD – May 2021

2. Introduction
Definition
Etiology
Management
Prognosis and complication
Summary

3. Epilepsy is one of the most common
serious neurological disorders worldwide
Affecting approximately 50 million people
60 to 70% of people with epilepsy will
achieve a remission from seizures
37 %  breakthrough seizures
Cockerell OC, Johnson AL, Sander JWAS, Hart YM, Shorvon SD. Remission of Epilepsy—Results from the National General-Practice Study of Epilepsy. Lancet.
1995;346(8968):140–4. ISI:A1995RJ03100008. pmid:7603228
Pellock JM, Dodson WE, Bourgeois BF. Pediatric Epilepsy: Diagnosis and Therapy: Third Edition: Springer Publishing Company; 2008.

4. An epileptic seizure which occurs
despite the use of antiepileptic drugs
that have otherwise successfully
prevented seizures in the patient
Bonnett LJ, Powell GA, Tudur Smith C, Marson AG. Breakthrough seizures—further analysis of the Standard versus New Antiepileptic Drugs (SANAD) study.
PloS one. 2017 Dec 21;12(12):e0190035.

5. Insufficient dose
Missed dose
Provoking factors such as emotional
stress, sleep deprivation, alcohol or other
recreational drugs, and TV or video games
Ongoing epileptogenic processes
Bonnett LJ, Powell GA, Tudur Smith C, Marson AG. Breakthrough seizures—further analysis of the Standard versus New Antiepileptic Drugs (SANAD) study.
PloS one. 2017 Dec 21;12(12):e0190035.

6. Identify the etiology (and avoid if possible)
Antiepileptic drugs adjustment
Use newer antiepileptic drugs
Montouris GD, Jagoda AS. Management of breakthrough seizures in the emergency department: continuity of patient care. Current medical research and
opinion. 2007 Jul 1;23(7):1583-92.

7. Unexpected by the patient, and therefore,
the person may not take appropriate
precautions.  injuries
Status epilepticus  ↑ morbidity and
mortality
Ettinger AB, Adiga R.K. Breakthrough Seizures—Approach to Prevention and Diagnosis. US Neurology. 2008;4(1):40–2.
Cherian A, Thomas SV. Status epilepticus. Annals of Indian Academy of Neurology. 2009;12(3):140–53. PMC2824929. pmid:20174493
Boggs JG. Mortality Associated with Status Epilepticus. Epilepsy Currents. 2004;4(1):25–7. PMC324580. pmid:15346141

8.  An epileptic seizure which occurs despite
the use of antiepileptic drugs that have
otherwise successfully prevented seizures
in the patient.
 Increase morbidity, mortality, and
economic burden.
Identify the etiology and treat the seizures