Lifestyle modification in epilepsy Lifestyle Modifications Lifestyle modifications can include: Adequate sleep: Fatigue is one of the most common seizure triggers, and disrupted sleep can make the brain more vulnerable to misfiring. Avoiding drugs and alcohol: These can be triggers for seizures in patients with epilepsy. Even one or two drinks can provoke seizures. Minimizing emotional stress: Although there is not definitive proof that stress causes seizures, those who maintain healthy stress levels have reported that they believe it reduces their risk. Frequency of exercise: In addition to a range of health benefits, regular exercise can help reduce risk of seizure. However, you should consult your physician before starting a new exercise routine, as some exercise can, rarely, cause seizures.

1. Amr Hassan, MD,FEBN
Professor of Neurology - Cairo University
Lifestyle Modification
in Epilepsy

2. • Specific time of day or night
• Sleep deprivation – overtired, not sleeping well, not getting enough
sleep
• At times of fevers or other illnesses
• Flashing bright lights or patterns
• Alcohol or drug use
• Stress
• Associated with menstrual cycle (women) or other hormonal
changes
• Not eating well, low blood sugar
• Specific foods, excess caffeine or other products that may aggravate
seizures
• Use of certain medication
Seizures triggers

3. Caffeine

4. • Preclinical studies suggest that caffeine increases
seizure susceptibility.
• In some cases, chronic use of caffeine may protect
against seizures.
• Caffeine lowers the efficacy of several drugs, especially
topiramate.
• It is unclear how these findings in models can be
translated to the clinical condition.
• Until clinical studies suggest otherwise, caffeine intake
should be considered as a factor in achieving and
maintaining seizure control in epilepsy.
Caffeine

5. Driving
• Huge variation from State to State
• Ranges from 3 months to 18 months
seizure-free periods
• Many States have ‘no set seizure-free
period

6. Epilepsy and Driving in Europe
E C Directive Group 1
• 1st Seizure
• Epilepsy
• Provoked seizure
• Sleep seizures
• Other seizures wihout
influence on driving ability
• Other loss of consciousness
• Seizure because of change of
medication
• 6 months
• 12 months
• Varies
• 12 months + no other seizures
• 12 months + no other seizures
• Varies
• 3 mo
Driving

7. Country Law
Seizure-
free
period
Andorra 2 years
Argentina
There are no specific laws prohibiting people with epilepsy from driving. Patients
generally rely on advice from their physicians.[6]
Australia
Patients must be seizure-free for 3–6 months for recently diagnosed seizures, and
for two years for chronic epilepsy.[7][8] Exact laws vary by state or territory.[6]
3 months
to 2 years
Austria
The most common seizure-free period required is 2 years, but in some cases, this
can be extended to 3. Insurance companies are not required to make liability
payments in accidents caused by seizures.[6]
2–3 years
Belgium Seizure-free period required depends on the type of seizure.[6] 1–2 years
Bermuda 1 year
Brazil 1 year
Bulgaria Those who have ever had a seizure are prohibited from driving.[9]
Canada Exact laws may vary by province/territory. See Canada below. 1 year
Central African
Republic
Those who have ever had a seizure are prohibited from driving.[9]
China Those who have ever had a seizure are prohibited from driving.[9]
Croatia 2 years
Cyprus 1 year
Czech Republic[10] Physician may set additional more restrictions (like no night driving), for
professional drivers seizure-free period is 10 years
1 year
Denmark
The national health board is involved in epilepsy cases in determining exact length
of disqualification, which is usually 2 years. Physician input is recommended.[6] 2 years
Egypt 2 years
Estonia
Required seizure-free period of one year for cars and motorcycles and of five years
for trucks and buses[11] 1–5 years

8. • Pace your exercise to avoid getting too tired or
hyperventilation.
• Avoid exercising in the middle of the day during hot weather.
• Try relaxation or slow breathing exercises when anxious or if
you begin to hyperventilate.
Exercise

9. Sports

10. Swimming

11. • The British Sub-Aqua Club (BSAC) currently
says that people must be seizure-free for five
years (or three years if seizures only happen in
their sleep) and off AEDs for five years, before
they consider scuba diving.
Scuba diving

12. Sleep

13. Stress, anxiety, depression

14. Stress, anxiety, depression

15. Mobile phones

16. Mobile phones

17. Reflex epilepsy

19. • Affects up to 5% of people with epilepsy.
• For someone with photosensitive epilepsy triggers can
include:
✓playing video games
✓watching moving computer games
✓watching a faulty television or other light source that
flickers slowly
✓strobe lights.
• The common rate for a flashing light to trigger seizures
is between 3 and 30 hertz (flashes per second).
Photosensitive epilepsy

20. Video Games induced seizures

21. • There are many mechanisms by which video
games may induce seizures. These are:
• Photosensitivity
• Pattern sensitivity
• Emotional and cognitive excitation (excitement or
frustration)
• Proprioceptive stimulation (movement/praxis).
• Fatigue, sleep deprivation and prolonged playing
are facilitating factors.
Video Games induced seizures

22. Video Games

23. • The Harding FPA (flash and pattern analyser)
is proprietary software.
• Used to analyse video content for flashing
and stationary patterns which may cause
harm to those who suffer from photosensitive
epilepsy.
The Harding FPA

24. The Harding FPA

25. • Installing an anti-glare cover for your computer
monitor
• Changing computer and display screen settings
• Closing window blinds and covering up other
contrasting light or visual patterns
• Opting for natural or warm lighting to avoid
fluorescents
Lifestyle modification in PSE

26. • Fixing any broken, flickering, or malfunctioning
light (fluorescent or otherwise)
• Taking frequent breaks to rest your eyes
• Wearing polarized sunglasses for outdoor
activities to reduce sharp glare.
• Avoid playing when having fatigue and insomnia.
• Photosensitive children should not play electronic
games when they are alone.
Lifestyle modification in PSE

27. • It refers to seizures induced
by television viewing in
photosensitive patients.
• children aged 10–12 years.
• There is a two-fold
preponderance of girls.
• Flickering television set or
at a close distance to the
screen.
Television Epilepsy

28. • Watch TV from a distance
of at least 2 m in a well-
illuminated room
• Use a remote control
• View on a 100 Hz TV.
• Try not to watch for a long
time especially while they
are tired and sleepy.
Lifestyle modification in TV-induced
seizures

29. Television and computer games

30. • Juvenile myoclonic epilepsy.
• Idiopathic photosensitive occipital lobe
epilepsy.
• Eyelid myoclonia with absences (Jeavons
syndrome)
Epileptic Syndromes of Photosensitivity

31. • Hot water epilepsy (HWE) is
induced by bathing with hot
water usually over 37 degrees
and pouring over the head.
• 2nd most common type of RE
after photosensitive epilepsy.
HWE

32. • Photosensitivity is reported to occur in
approximately 40% of patients with juvenile
myoclonic epilepsy.
• Sleep deprivation
• Alcohol intake
• HV
JME
CAE

33. LGS

35. • Once a day – take the forgotten dose as soon as you remember it;
or
• Twice a day – take the forgotten dose if you remember within six
hours after it was due, otherwise don’t take the forgotten dose
and just take the next dose at the due time.
• It is important that if you miss a dose you do not take twice as
much at the next dose time. Taking a larger dose than normal
could cause side effects.
Medication Schedule

36. Medication Schedule

37. Catamenial Seizures

38. THANK YOU
amrhasanneuro@kasralainy.edu.eg