What Triggers an Epileptic Seizure?

Living with epilepsy can be challenging. This brain disorder causes life-disrupting seizures. Antiseizure medications (also called antiepileptic drugs) can help. But you can also take steps, such as identifying seizure triggers, to minimize seizure risk.

“People with epilepsy have a threshold at which a seizure is more likely to occur when certain factors, or triggers, are present,” says Andrew J. Cole, MD, a Mass General Brigham neurologist and director of the Epilepsy Service at Massachusetts General Hospital. “Seizures from epilepsy are often unpredictable, but sometimes there’s an obvious reason.”

If you or someone you love is living with epilepsy, here are some triggers that may increase seizure risk.

Common seizure triggers

Seizure triggers are events or changes that take place before the onset of a seizure. The trigger may occur several hours or immediately before a seizure.

Alcohol use

Enjoying a drink or two is unlikely to bring on an immediate seizure. “Alcohol actually decreases excitability in the brain, which means it has more of an antiseizure effect while you’re drinking,” says Dr. Cole.

But overindulging, or binge drinking, increases the chances of a seizure happening the next day or even later. “The withdrawal from alcohol can cause hyperexcitability, or a misfiring of neurons in the brain, which brings on a seizure,” explains Dr. Cole.

Lower your seizure risk: Limit alcohol consumption to no more than two drinks per day.

Illnesses and treatments

Bacterial and viral infections that cause colds, other illnesses, and fevers can make you more prone to seizures. Many factors may be at play, including poor sleep, dehydration, and the overall stress of being ill. Conditions that cause vomiting can affect your ability to keep down seizure medications, which puts you at risk for seizures.

Some over-the-counter medications that treat illnesses or ease symptoms can make epileptic drugs less effective. The antihistamine ingredient diphenhydramine is one known culprit. Certain antibiotics, such as erythromycin, can heighten the effects of antiseizure medications, causing more side effects. You may also experience more seizures.

Lower your seizure risk: Talk to your health care provider or pharmacist about which medications are safe to take along with your antiseizure drugs. Let your provider know if vomiting affects your ability to take your epilepsy medicine.

Menstruation

About half of menstruating women with epilepsy experience an increase in seizures around the time of their periods. Hormonal changes cause this type of epilepsy, called catamenial epilepsy or menstrual seizures. Seizures most often occur around the time of ovulation, or a week before or during menstruation.

Lower your seizure risk: Some women may need to increase their antiseizure medication dosage or take an additional medication around the time of ovulation or menstruation. Progesterone hormone therapies or contraceptives (birth control) may also help keep hormone levels steady.

Photosensitivity

About 3 in 100 people with epilepsy have seizures after exposure to flashing lights or other visual stimulus. Anything with rapid flashes or alternating patterns of colors, including TV shows, movies, computer screens, and video games, can bring on a seizure. Children and teens are more prone to this type of photosensitive epilepsy. Most children outgrow these seizures as they get older.

Lower your seizure risk: Avoiding exposure to flashing lights isn’t always possible. Closing or covering your eyes often doesn’t help. Instead, cover one eye and turn away from the light source. You can also dim the brightness of your TV, computer, and phone screens, and sit farther away from the TV.

Poor sleep

Sleep gives your brain time to get rid of toxins that build up throughout the day, so you wake up feeling restored and refreshed. When you pull an all-nighter, consistently skimp on sleep, or have issues like insomnia or sleep apnea, your brain misses out on this much-needed repair time.

“Many people with epilepsy have seizures while they sleep, which is why it’s helpful to conduct certain diagnostic tests like electroencephalograms (EEGs) during sleep,” says Dr. Cole.

Lower your seizure risk: Talk to your health care provider if you’re having sleep problems. Some seizure medications can make you too sleepy or keep you awake. “You may be able to switch seizure medications or take the medicine at a different time of day,” he says. It’s also important to practice good sleep habits.

Stress

Stress may play a role in causing seizures, although the exact reason isn’t clear. “You probably aren’t sleeping or eating well when you’re under a lot of stress, which increase seizure risk,” says Dr. Cole. Stress also affects the heart and causes the release of cortisol, a hormone that increases heart rate and blood pressure. Increased levels of cortisol may also make you more susceptible to seizures.

Lower your seizure risk: Find healthy ways to manage stress, such as walking, yoga, meditation, gardening, or talking to a friend.

Identifying epileptic seizure triggers

Some people find it helpful to keep track of seizures and the events leading up to them in a journal, smartphone app, calendar, or other method. Your health care team helps determine what information you should track, such as:

• The time of the seizure
• What events were going on around the time of the seizure
• How you felt before and during the seizure

“Keeping track of seizures can be helpful when you’re struggling to get them under control,” says Dr. Cole. “But you shouldn’t keep this type of journal if it makes you anxious. It’s more important to inform your care team about the seizures, so you can work together to stop them.”