When someone experiences a seizure after being seizure-free with effective treatment for a period of time, it’s called a breakthrough seizure.

Some studies show that about 60 percent to 70 percent of people with epilepsy will go into remission from seizures with treatment. Of these, up to 37 percent will experience a breakthrough seizure.

Breakthrough seizures can happen to people with generalized seizures or other types of epilepsy. Any seizure after a seizure-free period should be reported to a doctor.

Understanding why breakthrough seizures happen and what can be done to prevent them can help a person with epilepsy improve their quality of life.

🗳️ If you’ve experienced a breakthrough seizure after being in remission with treatment, do you know what might have triggered it?

Missing one or more doses of anti-seizure medication

Stress, lack of sleep, alcohol, or another known seizure trigger

Another factor not listed here

I’m not sure what triggered my breakthrough seizure.

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What Causes Breakthrough Seizures?

Breakthrough seizures can happen due to several factors, including not taking anti-seizure medication as prescribed.

A study from The Egyptian Journal of Neurology, Psychiatry, and Neurosurgery found that the most commonly reported factors associated with breakthrough seizures were:

• Missed doses of prescribed medication — 56.4 percent
• Sleep deprivation — 36.4 percent
• Psychological stress — 34.5 percent

A study from the journal PLOS One noted that alcohol and drug use are also linked to breakthrough seizures. Flashing lights on television and in video games may trigger breakthrough seizures in some people with photosensitive epilepsy.

“I had a breakthrough seizure seven years ago. I accidentally left my medications at home when I went on vacation. I now keep a large supply of my medications in a bag in my purse at all times.”

— A MyEpilepsyTeam member

Other factors in breakthrough seizures may include:

Your Neurological History

Seizure history can be a significant predictor of a person’s risk of breakthrough seizures. The more tonic-clonic seizures a person has had before achieving remission, the more likely they are to have a breakthrough seizure while on treatment.

People with learning disabilities or known neurological impairments also have a higher likelihood of breakthrough seizures.

Your Treatment History

If it takes a person more than one year to achieve a seizure-free period on medication, then they’re at a higher risk of experiencing a breakthrough seizure. Similarly, if a person’s seizures require more than one medication to help them achieve seizure control, they’re at greater risk.

In some cases, a person may experience a breakthrough seizure just once. In other cases, a person’s seizures may become recurrent again. A study from the journal PLOS One showed that 63 percent of people who had their first breakthrough seizure went on to have seizure recurrence.

Gender as a Possible Factor

The same study found evidence that gender may also be a risk factor for breakthrough seizures. Men appear to be more likely to achieve 12-month seizure remission than women.

The reason behind a possible gender difference isn’t yet understood. One hypothesis is that men are possibly not reporting seizures as frequently as women, so as not to affect employment.

Using Generic Seizure Medications

Although FDA-approved generic medications must contain the same active ingredients and demonstrate bioequivalence to their brand-name counterparts, some people with epilepsy report experiencing breakthrough seizures after switching from a brand-name seizure medication to its generic version.

If you notice a difference in how a generic medication works compared to the brand-name version, let your doctor know. Never stop taking a medication (generic or brand name) without talking to your epilepsy specialist first.

Breakthrough Seizures on Keppra

Some evidence suggests an increased risk of experiencing breakthrough seizures when doses of the anti-seizure medication levetiracetam (Keppra) are missed. In animal trials, missed doses worsened seizure frequency by 85 percent and made seizures more severe.

Human studies have yet to confirm this, but it’s important to note that in general, missed doses have been established as a main cause of breakthrough seizures. Talk to your neurologist if you’re having trouble taking your medication consistently for any reason.

Next Steps After Breakthrough Seizures

If someone is taking their medication as prescribed and is experiencing breakthrough seizures, their doctor may recommend changing their medication regimen. However, if the breakthrough seizures result from missed medication doses or difficulty following the treatment plan, the doctor may discuss ways to help the person stay on track with treatment.

For people who experience breakthrough seizures as a result of triggering factors, it can be important to reduce stress levels and get enough sleep. Learning to use coping skills or taking part in psychological counseling can also be helpful.

Limiting alcohol intake is especially important in people who have seizures. Binge drinking and withdrawal from alcohol can trigger life-threatening seizures, including a condition known as status epilepticus.

Status epilepticus is defined as a seizure that lasts five minutes or longer, or multiple seizures within a short time period in which the person doesn’t fully recover between those seizures or return to their neurological baseline. Call 911 if a seizure lasts five minutes or longer or if another seizure begins before the person fully recovers.

Additionally, anti-seizure medications can lower alcohol tolerance, which means a person will feel intoxicated on less alcohol than they would normally drink. Alcohol interactions vary based on the type of medication you take, so talk to your doctor about possible interactions and side effects.

Reviewing a list of medications you take for other medical problems with your primary care physician and neurologist is also important. Some drug interactions occur with anti-seizure medications or can lower what’s called the “seizure threshold,” putting you at greater risk of experiencing a seizure or other side effects.

“Stress and lack of sleep seem to be my triggers. I was seizure-free for six years, and then I had a breakthrough seizure last summer.”

— A MyEpilepsyTeam member

Treating Breakthrough Seizures

Breakthrough seizures are treated similarly to other epileptic seizures. Anti-seizure medications are the first line of defense in epilepsy and may help prevent breakthrough seizures.

Your doctor will recommend anti-seizure medications based on your seizure type, age, any plans to become pregnant, other health conditions, and potential interactions with other medications you take.

Rescue medications also have a place in treating seizures, including breakthrough seizures. They act quickly to stop prolonged seizures or seizure clusters and may help prevent additional seizures.

If a doctor makes any changes to your medication prescription regimen or epilepsy management, it’s important to let your other healthcare providers know. These include:

• The emergency room doctor who may be the first to see you after a breakthrough seizure
• Your primary care doctor
• The neurologist managing your epilepsy
• Any other relevant healthcare providers

Not everyone responds in the same way to the same medication, as we each have our own unique brain and body chemistry. Many people need to try several drug treatments or drug therapies, including different dosages, to become seizure-free. Some people need to take a combination of seizure medications to achieve remission.

In one study, 44 percent of people with epilepsy had to stop or change their first treatment. However, 75 percent went on to have 12 months without seizures within six years of follow-up. This suggests that even when the first treatment doesn’t work out, many people can still become seizure-free with further treatment rather than developing refractory epilepsy.

Keep in Touch With Your Neurologist

If you experience breakthrough seizures, talk to your neurologist. They can work with you to adjust your epilepsy treatment plan to reduce the risk of future breakthrough seizures.

Once you find something that works for you, stick with it. Always talk to your care team before making any changes to your treatment plan, and be sure to follow your doctor’s instructions closely.