Breakthrough seizure
Encyclopedia
A breakthrough seizure is an epileptic seizure that occurs, despite the use of anticonvulsant
s that have otherwise successfully prevented seizures in the patient. Breakthrough seizures may be more dangerous than non-breakthrough seizures because they may be less expected by the patient, who already considered him/herself free from seizures and therefore, not take any precautions.
Epileptics with a higher intensity of seizures are more likely to suffer from a breakthrough seizure.
Often when a breakthrough seizure occurs in a person whose seizures have always been well-controlled, there is a new underlying cause to the seizure.
One who suffers a breakthrough seizure when s/he is not known to have them may require hospitalization for a period of time for observation.
Anticonvulsant
The anticonvulsants are a diverse group of pharmaceuticals used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and in the treatment of neuropathic pain. The goal of an...
s that have otherwise successfully prevented seizures in the patient. Breakthrough seizures may be more dangerous than non-breakthrough seizures because they may be less expected by the patient, who already considered him/herself free from seizures and therefore, not take any precautions.
Epileptics with a higher intensity of seizures are more likely to suffer from a breakthrough seizure.
Often when a breakthrough seizure occurs in a person whose seizures have always been well-controlled, there is a new underlying cause to the seizure.
Causes
Causes of a breakthrough seizure may include:- Missed dose of an anticonvulsant. This is the most common cause, and it may even result in status epilepticusStatus epilepticusStatus epilepticus is a life-threatening condition in which the brain is in a state of persistent seizure. Definitions vary, but traditionally it is defined as one continuous unremitting seizure lasting longer than 5 minutes, or recurrent seizures without regaining consciousness between seizures...
. In some patients, even a single missed dose may be responsible for a breakthrough seizure. - Incorrectly timed dose: This may occur, for example, if a patient takes a dose a little later than s/he should. Also, a patient traveling across time zone lines may alter their medicating schedule, resulting in interference with the therapeutic effects of the drug
- Incorrect dosage amount: A patient may be receiving a sub-therapeutic level of the anticonvulsant
- Switching medicines: This may include sudden withdrawal of an anticonvulsant without replacing it at all, or to switch abruptly to another anticonvulsant. In some cases, switching from brand to the genericGeneric drugA generic drug is a drug defined as "a drug product that is comparable to brand/reference listed drug product in dosage form, strength, route of administration, quality and performance characteristics, and intended use." It has also been defined as a term referring to any drug marketed under its...
version of the same medicine may induce a breakthrough seizure. - Sleep DeprivationSleep deprivationSleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain. It adversely affects the brain and cognitive function. Few studies have compared the...
: Failure to get enough restorative sleep in some patients may result in a seizure. This will often be the patient's only change in routine prior to a seizure. - Stress
- Alcohol or drug use by people with epilepsy. Even consumption of caffeineCaffeineCaffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
can result in a seizure in some. - Some over-the-counter drugOver-the-counter drugOver-the-counter drugs are medicines that may be sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription...
s in some patients - MenstruationMenstruationMenstruation is the shedding of the uterine lining . It occurs on a regular basis in sexually reproductive-age females of certain mammal species. This article focuses on human menstruation.-Overview:...
in women of childbearing age. This may be the result of hormonal fluctuation or over-the-counter drugs that are used to treat symptoms of menstruation. - Acute illness: Some illnesses caused by virusVirusA virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses infect all types of organisms, from animals and plants to bacteria and archaea...
es or bacteria may lead to a seizure in epileptics. Especially when vomitingVomitingVomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
or diarrheaDiarrheaDiarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
occur, this may reduce the absorption of the anticonvulsant. - MalnutritionMalnutritionMalnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
: May be the result of poor dietary habits, lack of access to proper nourishment, or fastingFastingFasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. An absolute fast is normally defined as abstinence from all food and liquid for a defined period, usually a single day , or several days. Other fasts may be only partially restrictive,...
. - In seizures that are controlled by diet in children, a child may break from the diet on their own.
- Drug interactionDrug interactionA drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind...
s caused by antihistamines and antidepressants lower the effectiveness of anticonvulsants.
Rates
Rates of breakthrough seizures vary. Studies have shown the rates of breakthrough seizures ranging from 11-37%.Treatment
The treatment for a breakthrough seizure involves measuring the level of the anticonvulsant in the patient's system, and may include increasing the dosage of the existing medication, adding another medication in addition to the existing one, or altogether switching medications.One who suffers a breakthrough seizure when s/he is not known to have them may require hospitalization for a period of time for observation.