Common Seizure Triggers: What Triggers Attacks in Epilepsy?

Epileptic seizures can occur at random times without warning, but many people find that their seizures are precipitated by specific triggers. Many things can trigger seizures, and each person’s experience is different. A seizure trigger can be a specific sight or sound, a substance, or a physiologic state (such as having low blood sugar).

Most seizure triggers can increase excitability in the brain, increasing activity and lowering the seizure threshold. Triggers do not cause epilepsy (the underlying causes of epilepsy vary from genetic predisposition to illness and injury) but rather put your brain into a state where it is more likely to have seizure activity. It is important to identify what triggers your seizures and to learn how you can avoid those triggers.

Common Seizure Triggers

Some of the most common seizure triggers include:

• Missing a dose of epilepsy medication
• Stress
• Lack of sleep
• Alcohol
• Withdrawal from narcotics or barbiturates
• Caffeine
• Flashing lights or patterns
• Low blood sugar
• Time of day
• Hormonal changes
• Fever
• Infection or other illness

Missed Medication

Failure to take your antiepileptic drugs (AEDs) as prescribed is one of the most common seizure triggers. AEDs work by preventing seizure activity in the brain, but for the medication to work properly, you must have a high enough level of medication in your bloodstream. Missing a dose or taking the wrong dose of your AED can decrease these levels and trigger seizures.

Stress

Stress is another commonly reported trigger. Emotional or psychological stress, including anxiety, anger, depression, or other heightened emotional states, can trigger a seizure in some people. Stress can also contribute to other triggers, such as lack of sleep.

Inadequate Sleep

Lack of sleep is one of the top triggers for epileptic seizures in many people. Lack of sleep may be due to a change in schedule, insomnia, medication side effects, poor sleep quality, alcohol consumption, caffeine consumption, and even seizures during sleep.

Alcohol

Alcohol consumption can lead to seizures. Some people with epilepsy can tolerate small amounts of alcohol, but others may have seizures after only one drink. Binge drinking — drinking until you are intoxicated — is a very common trigger. Seizures triggered by alcohol can occur anywhere from one to two hours after drinking and up to 48 hours after stopping heavy drinking. Alcohol can also trigger seizures by changing your blood levels of AEDs and other medications. Finally, alcohol can also negatively affect your sleep, contributing to potential seizures.

Caffeine, Nicotine, and Other Substances

Caffeine and nicotine are commonly used stimulants that can lower your seizure threshold. Coffee, tea, soda, and chocolate can all have high levels of caffeine. When taken in large amounts, caffeine and other stimulants can increase the excitability in the brain. Other recreational and illicit drugs, such as cocaine, amphetamines, and MDMA (ecstasy or molly), can induce seizures in people with epilepsy.

Some medications, including over-the-counter options, can change how the body processes your AEDs, leading to seizures. Always check with your health care provider or pharmacist to see if any of your medication or supplements interact with your epilepsy medication.

Flashing Lights

Flashing lights and certain patterns (such as optical illusions that appear to move) can trigger seizures in some people with photosensitive epilepsy. The frequency of flashing light that triggers seizures varies from person to person. Sometimes, high-contrast geometric patterns can also trigger these types of seizures.

Low Blood Sugar

Low blood sugar, or hypoglycemia, may trigger seizures. Skipping meals or eating at irregular times can cause fluctuations in blood sugar.

Time of Day

Some people have seizures at a specific time of day or night, including while they are sleeping.

Hormonal Changes

During the normal menstrual cycle, the female body goes through changes in levels of the hormones estrogen and progesterone. Changing hormone levels can be a seizure trigger.

Fever

High fever due to infection or other illness can cause febrile seizures. Children are more susceptible to febrile seizures than adults.

How To Identify Your Seizure Triggers

Identifying what specific triggers you are susceptible to is the first step in finding ways to avoid triggering seizures. Identifying what induces your seizures can also help you and your health care provider pinpoint your diagnosis and determine the best treatment for your situation.

To figure out what triggers you have, try keeping a journal of your seizures. If you are not able to keep a journal yourself, ask a caretaker to help you track your seizures. Journal entries could include:

• The time and date of the seizure
• Your physical location
• What you were doing at the time
• The dose and time of your last AED
• What you had been eating and drinking, especially if it includes alcohol or caffeine
• What other drugs or medications you had been taking, including prescription, over-the-counter, herbal, and illicit substances
• How much sleep you had
• Your mood
• If applicable, where you are in your menstrual cycle or the date of your last period

It is also important to note if you experience auras before your seizures. Auras can be visual disturbances, odd physical sensations, or emotions that you experience before your seizure. In epilepsy, auras can be types of seizures.

All of the information you gather about your seizures should be shared with your doctor or health care provider to help them determine what care is best for you.

See what Dr. Jonathan C. Edwards says about identifying and tracking seizure triggers.

How To Avoid Seizure Triggers

Once you know what triggers your seizures, you may be able to avoid those triggers or lessen their impact. Depending on the type of trigger, there are many ways to help prevent seizures.

Take Your Medication as Prescribed

Take your prescribed AED medication as directed, including taking the right dose at the right time. Do not adjust the dosage or stop taking any antiepileptic medication without first consulting your doctor. Take steps to ensure that you take your medication regularly:

• Use a pillbox to organize your medications by day and time.
• Keep track of your doses using a calendar.
• Set alarms to remind you to take your medicine.
• Use an app that helps you stay organized.

Alleviate Stress

Controlling stress can be difficult, but managing stress is important for your health. You cannot always control what causes emotional or psychological stress, but you can identify stressors and work to reduce the negative impact these things can have on your life.

Coping strategies can include anything from meditation to exercise to ensuring your sleeping habits are in good shape. Seeking the help of a psychologist or other counselor is also helpful for many people who have trouble dealing with stress and emotional difficulty in life.

Get Some Sleep

Getting a good night’s rest is important for proper brain function in all people and especially for those living with epilepsy. Maintaining good sleep hygiene can include keeping a regular schedule for going to bed and waking up, controlling pain that affects sleep, not reading or watching TV in bed, and avoiding caffeine as well as other stimulants, alcohol, and large meals before bedtime. Like taking your medication, getting the proper amount of sleep at the right time is important for controlling seizures.

Avoid Alcohol

Avoiding alcohol altogether is generally the safest approach to prevent alcohol-triggered seizures. However, people who are addicted to alcohol or drink significant amounts of alcohol regularly may be at increased risk of seizures when they stop drinking. If you’re dependent on alcohol, seek medical advice to avoid problems from alcohol withdrawal.

Avoid Caffeine, Nicotine, and Other Substances

Limiting or eliminating caffeine or nicotine intake can decrease your risk of seizure if it is a trigger for you. Other drugs that trigger seizures, including recreational and illicit substances, should be avoided.

Avoid Flashing Lights

If you have photosensitive epilepsy, you can work with your doctor to determine what specific frequencies of flashing lights or types of patterns induce seizures. Your doctor may use a test called an electroencephalogram (also called an EEG) to make the determination.

It may not be possible to always avoid light triggers, but you can sometimes lessen the risk of having a seizure by simply covering one eye.

Eat Better

A healthy diet contributes to a healthy body. Eliminating food triggers from your diet is important, but so is eating better. You can prevent low blood sugar by eating regularly and avoiding foods that cause your body to produce more insulin.

Eating a ketogenic diet is another approach that may help control seizures, especially when antiepilepsy medication does not work. Adults and children with epilepsy can often benefit from a ketogenic diet or a similarly restricted diet.

Plan Around Your Menstrual Cycle

For some women, using hormonal treatments, such as certain hormonal birth control methods, can help prevent seizure triggers by altering the normal menstrual cycle. Your doctor may also adjust your AED dose or add additional AED medications at specific times during your menstrual cycle to help prevent seizures.

Treat at the First Sign of Illness

It is not possible to simply avoid getting sick, but seeking medical treatment at the first sign of fever, infection, or other illness can help prevent seizures. Always check for medication interactions, including antibiotics.

Talk With Others Who Understand

MyEpilepsyTeam is the social network for people with epilepsy. On MyEpilepsyTeam, nearly 100,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Do you know your seizure triggers? Share your thoughts in the comments below, or start a conversation by posting on MyEpilepsyTeam.