“Trigger warning” has become a buzzword in the US. It’s generally used to warn people that something they are about to see or read could cause an emotional — and often unpleasant — response. But in the epilepsy world, “trigger” has a little different meaning: It is something that can bring on a seizure, or a “seizure trigger”.
First Things First: Epilepsy 101
Epilepsy (also known as a seizure disorder) is a neurological condition, meaning it affects your brain and nerves.
Seizures occur when there are disturbances in the electrical activity of your brain. If you have at least two seizures, and they aren’t caused by another known medical condition, you may be diagnosed with epilepsy.
When people think of seizures, they often picture someone falling on the ground and convulsing (shaking). That’s actually just one of dozens of types of seizures. Depending on where in the brain the seizure occurs, seizures can cause:
- Shaking
- Twitches
- Confusion
- Blank stares
- Pain
- Changes in sensation (hearing, vision, taste)
- Feelings of fear, anxiety, dread, or even pleasure
- Changes in heart rate or breathing
- Stiffness throughout the body
- Repeated or automatic movements
Epilepsy can be caused by many different brain abnormalities. Sometimes it’s the result of a head injury or it runs in the family. But in about 50% of cases, there’s no known cause. Fortunately, most people with epilepsy can control their seizures with medication, surgery, or medical devices.
What Triggers Epileptic Seizures?
No two cases of epilepsy are exactly the same. One person’s seizure triggers may be completely different than someone else’s triggers.
But in general, there are several well-known — and extremely common — triggers.
1. Missed Medication
Missed medication is the #1 reason why people with controlled seizures have breakthrough ones (sudden, unexpected seizures in a person who previously had control over their seizures).
If you don’t have controlled seizures, missing medication can cause your seizures to occur more often than usual or be more intense. They can even lead to long seizures called status epilepticus, which is a medical emergency that’s potentially life-threatening if the seizures aren’t stopped.
Missing one dose isn’t necessarily cause for panic — it’s common for people to miss a dose every so often. And in most cases, nothing bad happens.
If you do miss your medication, the general rule of thumb is to take your medicine as soon as you remember it, unless it’s almost time for your next dose. Avoid doubling up on your doses.
And if you’re not quite sure what to do? Call your physician or pharmacist, and they can give you guidance.
2. Lack of Sleep
Getting a good night’s sleep is important for everyone, but it’s especially important if you have epilepsy.
While you’re sleeping, there are changes in your brain’s electrical and hormonal activity. These changes can be triggers, which is why some people tend to have seizures while they are sleeping. The changes can also trigger seizures in people who haven’t gotten enough sleep.
Unfortunately, epilepsy and sleep work in a bit of a vicious cycle. Epilepsy can disturb your sleep, but sleep deprivation can aggravate your seizures. Some epilepsy medications cause side effects like insomnia that can keep you from falling or staying asleep. Also, people with epilepsy are more prone to sleep apnea — a condition that further impacts sleep.
The National Sleep Foundation recommends that people ages 18 to 64 get 7 to 9 hours per night.
3. Stress
Stress can take a physical toll on your body. It can cause headaches, sleeplessness, or increase your risk for conditions like heart disease or diabetes, if it is long-lasting. If you have epilepsy, stress can also bring on seizures.
The exact reason why this happens isn’t totally understood, especially because stress is subjective and can be different from person to person.
One study did find that some people feel a loss of control when they are stressed, and develop worry and fear (anxiety). This can cause someone to hyperventilate — breath rapidly and deeply — which can increase abnormal brain activity and provoke seizures.
Just like sleep, stress and epilepsy are a double-edged sword. Stress, anxiety, and other mood disorders can trigger seizures, but these are fairly common among people with epilepsy.
If you are frequently stressed, talk to your physician or a mental health professional to see if you have a treatable mood disorder or to discuss ways to lower your stress levels. It’s also a good idea to have some quick stress relief methods in your back pocket, like deep breathing or relaxation techniques, for when stressful situations occur.
4. Alcohol
In small amounts (think 1 to 2 standard drinks) alcohol doesn’t typically cause seizures. However, binge drinking — having too much alcohol at once in a short period of time — or having 3 or more drinks can be triggers.
Alcohol-related seizures usually occur during withdrawal, when alcohol is leaving your system. This means that if you’re drinking and aren’t having seizures, you’re not necessarily in the clear — seizures could come later on.
Also, some seizure medications can lower your tolerance for alcohol. It may take you fewer drinks to feel the effects of being intoxicated, like dizziness or vomiting, than people who aren’t on those medications.
If you are going to drink, pay extra attention to how much you’re drinking. Remember that 1 to 2 standard drinks doesn’t just mean 1 to 2 glasses — it’s the actual amount of alcohol. A standard drink is:
- 12 oz of beer
- 5 oz of wine
- 1.5 oz of distilled spirits
Withdrawal seizures can occur 6 to 72 hours after you’ve stopped drinking. It’s a good idea to avoid being alone after drinking in case you do have a seizure.
5. Menstruation
About half of women of childbearing age with epilepsy have increased seizures around their period. This is most likely due to hormonal changes that occur during your monthly cycle.
Your brain has many nerves that are directly affected by the main sex hormones in women — estrogen and progesterone. At high doses, estrogen can cause or worsen seizures. On the other hand, progesterone can actually protect against seizures.
During your cycle, there may be times when you don’t get enough progesterone, or the balance between the two hormones is off. And that’s when seizures are more likely to occur.
A Note About Birth Control
Hormone-based contraceptives combine estrogen and progesterone, or just progesterone. Oral contraceptives (“the pill”) are the most common. For many women with epilepsy, the pill is safe. For others, certain types of birth control pills can increase seizures.
This is particularly common if you take lamotrigine (Lamictal). Hormone-based birth control with estrogen lowers the amount of lamotrigine in the blood by 50%, making it much less effective.
The relationship between hormone-based birth control and epilepsy medication can go the other way, too. Some epilepsy drugs increase the liver’s ability to break down hormones, which decreases the effectiveness of birth control.
Hormone-based birth control is often safe and effective for women with epilepsy, so you don’t necessarily need to shy away from it. However, your provider may recommend using a birth control method without hormones, such as condoms or non-hormone based intrauterine devices (IUDs), and using back-up forms of birth control.
6. The Common Cold...or a Sinus Infection...or the Flu
Fever, the physical stress of being sick, and dehydration (from not drinking or eating normally, or from vomiting) can all bring on seizures. It can also be hard to get a good night’s sleep while sick, and lack of sleep can be a trigger. Plus, some of the medications used to treat these ailments may be triggers.
7. A Whole Host of Other Things
Missed medication, lack of sleep, stress, alcohol, and menstruation are some of the most common triggers, but there are many more.
Flashing lights can cause seizures in some people, but it’s much less frequent than you might imagine. In fact, only 3% of people with epilepsy are photosensitive (react to flashing lights).
Other less common seizure triggers include:
Herbal Medications and Supplements
Herbal medications — as well as the herbs that go into many dietary supplements — can actually cause seizures or worsen side effects of seizure medication. The same goes with essential oils. Certain ones, such as juniper and umbrella plant, have been known to induce seizures.
Nutrient Deficiencies
Vitamin B6 (pyridoxine) deficiency is the only type of vitamin deficiency that’s been proven to potentially cause or worsen seizures. This usually occurs in newborns and infants.
In some people, low levels of sodium, magnesium, and calcium can alter the brain’s electrical activity and cause seizures. Deficiencies of these are generally from underlying problems, like kidney disease or hormonal disorders.
The Final Word
It doesn’t matter whether the cause is known or not, or if you’re the only person your physician has heard of with that trigger. You know your body best, so if something regularly triggers seizures, take it seriously and do your best to avoid it.
One of the most important things you can do is talk to your provider. Don’t try a new treatment, or let the possibility of a seizure scare you away from an antibiotic, or even seeing a movie, without talking to your provider, first.