Breakthrough Seizures: What Are The Causes?

Epilepsy is among the most common neurological disorders around the world. It affects approximately 50 million people. Most people with epilepsy can achieve remission from seizures; however, 37% of these individuals develop breakthrough seizures.

Breakthrough seizures are sudden and unexpected seizures that occur in people with epilepsy who generally have good control over the symptoms. Breakthrough seizures are generally defined as epileptic seizures that occur even with antiepileptic medications that have prevented seizures in the past or seizures in people who generally have had good control of epilepsy. 

Breakthrough seizures can occur due to changes in drug usage, such as forgetting a dose or taking a smaller amount of medication than prescribed. Other factors that can trigger breakthrough seizures include alcohol withdrawal, illness, vomiting, electrolyte imbalance, and fever. Sometimes, the reason for breakthrough seizures is unknown. 

What are the causes of breakthrough seizures?

There are many potential causes of an unexpected breakthrough seizure. Some individuals may find that seizures are triggered under specific conditions. People with epilepsy must be aware of factors that may induce seizures and avoid them.

Breakthrough seizures are often caused by changes to a patient's medication, either through forgetting to take their prescribed anti-epileptic drugs or changing the dosage. 

Adhering to prescribed medications is a very important factor in seizure control for epileptic people, as not taking medicines as prescribed can contribute to breakthrough seizures and other complications of epilepsy. 

Other factors can trigger breakthrough seizures. These factors can include the following:

• Emotional stress

• Changes in nutrition, e.g., dehydration and low or high blood sugar

• Changes to sleep patterns or disrupted sleep

• Infections and illness

• Hormonal changes, e.g., menstruation

• Photosensitivity, e.g., flashing lights

• Excess caffeine

• Alcohol and drug use

Triggers of seizures can’t always be completely avoided, even with medications being taken as prescribed.

Are breakthrough seizures dangerous?

Some experts argue that breakthrough seizures bring greater risks than non-breakthrough seizures. This is often because they aren’t expected, which may mean that the individual isn’t prepared. 

Breakthrough seizures may have consequences as the person may have to be admitted to the hospital due to the seizure or injuries caused by the seizure. 

Are breakthrough seizures common?

Breakthrough seizures are estimated to occur in 39–75.3%¹ of people with epilepsy. However, this data is representative of prevalence in developing countries. Few studies have been done to look at the prevalence and factors behind breakthrough seizures and their outcomes. 

What are the known risks of breakthrough seizures?

Simply having epilepsy brings risks. The comorbidities, economic strain, psychological strain, and social stigma can be challenging for people with epilepsy. However, improvements in quality of life are possible for many people with this condition. 

Sometimes, even a single missed dose of antiseizure medication can lead to an individual having a breakthrough seizure. People with epilepsy not adhering to their prescriptions can suffer serious consequences.

Safety tips for seizures

The consequences of breakthrough seizures can be severe, but many steps can be taken to mitigate these risks.

Wearing a medical alert bracelet is a great way to let people and emergency responders know about your condition and give you proper treatment.

Medications are another way to manage epilepsy and reduce the occurrence of breakthrough seizures and associated injuries. It’s important that people with epilepsy use medications or other treatments to minimize their risk of having a seizure. Also, improving the safety of their home and the environments they frequent, such as the office, can help to protect them. 

At home

• Replace glass surfaces such as windows and shower doors with safety glass to minimize the risk of falling through glass, which may result in severe cuts.

• Keep interior doors, such as those in bathrooms, unlocked so that your loved ones can reach you if you have a seizure.

• Take showers instead of baths to reduce the risk of drowning during a seizure.

In the workplace

• Tell your manager or the human resources department. Teach them how to respond to a person having a seizure.

The lowdown

Breakthrough seizures can occur in individuals with epilepsy despite the use of antiseizure medication. This type of seizure can be dangerous as the individual may not be prepared for it and may not have the proper precautions in place, which may lead to injury. 

Breakthrough seizures have several potential triggers, which include fever, not following instructions for prescription drugs, poor sleep, and alcohol use.