	epilepsyfoundation.org \| en español \| Local Support \| Join/Login
	First Aid Medications Find a Doctor eNewsletter eCommunities

Epilepsy Foundation Northwest

Epilepsy Foundation » Local Services » Epilepsy Foundation Northwest » Ask the Experts

Questions about Epilepsy? Ask the Expert

For more detailed information on new treatments, drugs and research, visit our "Epilepsy Updates" page.

Please note that advice in Ask the Expert is for educational purposes only. Always seek the advice of your healthcare provider regarding your personal health issues.

April 2008

Question: "Can vaccines cause seizures?"

Answer by Russel Saneto, DO, Ph. D.

The CDC reports that seizures are associated with immunizations about 1 in every 10,000 immunizations. DTP immunizations have a 2 - 3 fold increase in seizures on the day of immunization and MMR has a slight increase in seizures 1 - 2 weeks after immunization. It is the recommendation that all patients with epilepsy have immunizations by the CDC. We usually tell parents to use Tylenol the day of immunizations with DPT to prevent fever.

There is one caveat to this. If a patient has a mutation in the SCN1A gene, then any fever can be very problematic. In one study out of Australia there were a significant percentage of children who developed seizures after immunization who had a mutation in this gene.

Fortunately, most children do not have this mutation. In those children with the SCN1A gene mutation, I usually give them extra medication before their immunization.

It would be far worse for anyone with epilepsy to develop any of these diseases with respect to any seizure event caused by the immunization itself. This is not so far fetched as this past year there was an outbreak of pertussis at our Hospital and within the region. To get a job at Children's Hospital, every one has to be vaccinated against pertussis. This would show that even with the best prevention, exposure and disease are possible.

October 2007

Question: How can I save money on my Antiepileptic drugs?

Answer by David G. Vossler, M.D.

Here are just some of the way for you and your healthcare provider to help you save money on antiepileptic medications (AEDs):

Use the largest pill size available – multiple small pills cost lots more than one large pill
Get a pill cutter at your pharmacy and cut large pills in half (if that is what your dose calls for). For example, if your dose of Topamax is 100 mg twice a day you could use the 100 mg tablet size, but it costs less to use half of a 200 mg tablet
Ask your provider if it is okay to use a generic, rather than brand name, AED
Simplify dosing regimens: rather than use two tablet sizes of the same AED to achieve intermediate individual doses, consider cutting larger tablets in half. For example, if your dose of Trileptal is 450 mg twice a day, instead of using one 150 mg pill and one 300 mg pill to make 450 mg, you could take 1-1/2 300 mg tablets.
If possible and indicated, ask your doctor about using the older generation AEDs
Use 90-day mail-order pharmacies rather than monthly local pharmacies
If you must pay cash, call local pharmacies and ask their retail prices. Shopping around can save you money.

September 2007

Question: Should I avoid certain kinds of foods or drinks if I have epilepsy? Can I drink coffee?

Answer by Nicholas Poolos, M.D.

I hear this question frequently in clinic. The only clear answer to this question is that alcohol and epilepsy don't mix well. Consuming large amounts of alcohol raises the risk of a withdrawal seizure as blood alcohol levels decline following drinking. We know that people without epilepsy can provoke a seizure just from alcohol withdrawal, and for people with epilepsy, the risks are even higher.

Another risk of drinking is that if alcohol intake occurs on a consistent daily basis, the liver increases its metabolism to compensate, and metabolizes many antiepileptic drugs faster too, lowering their blood levels. This doesn't mean that people with epilepsy have to completely avoid alcohol, but I suggest they use great caution, no more than a drink or so at a time, and only on an infrequent basis.

As for coffee--or rather the caffeine in coffee, tea, and soda--some researchers have reported that caffeine could make seizures more likely. This is because caffeine is a mild stimulant. I don't think there's strong evidence for this, but as for all things, keeping caffeine intake moderate is a good idea.

However, more dangerous stimulants can turn up in unexpected places, such as herbal supplements advertised for 'energy' or 'weight-loss'; these often contain substances known to provoke seizures, such as kava kava, bitter orange, or ephedra, and should be avoided. (In general, if you're taking any kind of herbal supplement, always discuss it with your physician.) And it goes without saying that illegal stimulant drugs such as methamphetamine or cocaine will provoke seizures.

Finally, on the subject of foods that might affect epilepsy or antiepileptic drugs, grapefruit juice is known to inhibit the metabolism of a number of drugs, including possibly carbamazepine (Tegretol)--but I think you'd have to drink a lot of it to experience any effects.

August 2007

Question: I only have seizures when I am asleep. Why?

Answer by John W. Miller, MD, PhD

Although many people with epilepsy find that their seizures are affected by sleep, different individuals have very different patterns. Some only have seizures during sleep; some only have them when they are awake.

It’s also not unusual for seizures to be stronger if they happen during sleep. People with some types of epilepsy often have seizures right after they wake up in the morning. With most types of epilepsy, lack of sleep or poor sleep can trigger seizures.

There are great differences in the electrical and chemical activity of different brain regions during wakefulness, quiet sleep, and dreaming sleep, and these differences must explain why a person’s state of arousal or sleep can trigger seizures. However, the relationship between sleep and seizures is so variable in different people, that researchers do not have answers that apply to everyone with epilepsy.

The most important thing is to understand how sleep affects your epilepsy. It is important to get enough sleep. If you have a sleep problem, such as insomnia (trouble falling or staying asleep) or sleep apnea, treating the sleep problem may help to control your seizures. If you have to get up early in the morning, be sure to go to bed early enough to get a good night’s sleep. If you find that your seizures typically happen at certain times of night or day, you should be extra careful at those times. Talk to you doctor so that you can understand how sleep affects your seizures, and what you can do about it.

July 2007

Question: I had a seizure; if I tell my doctor, does he have to report it to the Department of Licensing?

Answer by Nicholas Poolos, MD

Whether or not a physician is required by law to report a patient with uncontrolled seizures to the motor vehicle bureau varies by state. Only six states at present are "reporting" states. Oregon is one of them, but Washington State is not. In both Oregon and Washington, anyone who has had a loss of consciousness for any reason, seizures included, must refrain from driving for six months. However, in Washington, it is up to the patient to report that fact to the Department of Licensing when their driver's license comes up for renewal, not their physician. I think that most physicians prefer not to be required to report their patients to the motor vehicle bureau--it just puts a barrier between the doctor and patient, discouraging the patient from informing the doctor about breakthrough seizures and getting the care they need.

For more information on this topic, including driving laws for each state, please visit our special section on driving and epilepsy.

June 2007

Question: Can strenuous exercise bring on a seizure?

Answer by Nicholas Poolos, MD

If you are asking this because you're actually getting strenuous exercise on a regular basis… then good for you! Getting your heart rate up with vigorous physical activity is an important part of being healthy, and having epilepsy shouldn't be a limitation to exercise. To answer the question more directly--it probably depends on just how "strenuous" the exercise is. In general, exercise should not precipitate seizures, but it's possible that really strenuous activity that left one dehydrated or overheated might provoke a seizure.

Also, a small proportion--a few percent--of those with epilepsy can provoke seizures with hyperventilation (breathing rapidly), so these people might be at risk of provoking a seizure with vigorous aerobic activity. If you are just starting out on a exercise program, our advice is to gradually increase the intensity of your workouts, and stay well-hydrated. But don't let epilepsy prevent you from exercising!