May 12, 2021

Interviewer: Lifestyle changes that you can make to decrease the severity or number of seizures that you have. Dr. Sindhu Richards is an assistant professor of neurology at University of Utah Health. She specializes in treating epilepsy.

Dr. Richards, what are some of the recommendations you would give somebody who would like to make some lifestyle changes or look at their lifestyle as a way to reduce the number or the intensity of their seizures?

Dr. Richards: So one of the biggest things that can affect the seizure burden is the quality of sleep. So people who have sleep deprivation is a big trigger for seizures. So we say getting adequate amount of sleep every night, trying not to stay up late, having a regular sleep cycle will be really beneficial in terms of reducing the amount of seizures you have.

And in correlation to that, one of a common diagnosis of patients with epilepsy can have is obstructive sleep apnea. And so that's just where they're not getting good quality of sleep and might need a CPAP machine in order to do that.

And so people who get treated for sleep apnea tend to have a lower seizure burden as well, just because when they're treated for sleep apnea, they are getting better quality sleep. Even though they might be sleeping still a full eight to nine hours a night, but that quality is not great if they have untreated sleep apnea. So that's known to worsen seizures as well.

And then also, we also counsel people on alcohol use. So having an occasional glass here to there, or even a glass of wine a night is totally fine to do in patients who have epilepsy. We just get more concerned for like the binge alcohol use, because that is more so clearly linked with sleep deprivation as well. And then any significant alcohol use can actually provoke a seizure disorder itself. So we advise against a moderate to severe amount of alcohol use, but having a glass here or there or even drinking socially, occasionally is fine if you have epilepsy.

Another common thing that I get asked is any dietary changes and whether that can help with epilepsy. So in terms of in the adult population, there's not really clear evidence in sort of certain diets improving seizure frequency.

So in the pediatric population, there are certain seizure types that respond to the ketogenic diet. So if people with epilepsy really want to try a dietary measure to see if it reduces their seizure frequency, that is usually one I suggest just because it has good evidence in the peds world, but it doesn't in the adult world, but we know it doesn't do any harm in terms of seizure frequency. But in terms of like reducing other sugars or any other taking out any major dietary substance, we don't really recommend that in terms of in epilepsy.

Interviewer: So then to be clear, like the diet might not have good evidence behind it. Meaning I know physicians really like to have that evidence that shows yes, there is a direct link. That doesn't necessarily it might mean it might not help somebody. So if you want to talk to your doctor to make sure that the ketogenic diet is okay for you or some of these other dietary adjustments, that would probably be the first step to make sure it doesn't affect something else. But as far as epilepsy is concerned, it wouldn't impact that.

Dr. Richard: Exactly. Yeah. It wouldn't make it worse. So yeah, you would make sure to check with your like primary care doctor to see if that's an acceptable diet for you to go on.

Interviewer: Are there any other lifestyle things that somebody could look at or adjust or lifestyle things you've been asked about that we just don't know.

Dr. Richards: Those are the big ones I would say. We try to, you know, patients with epilepsy, we want you to live the best normal life you can. So continuing to be active, like exercising, that's all great in terms of any medical problem, but it's also great for epilepsy as well because that's another question we get.

We obviously don't want you to do any major exercise or activity where you would cause like serious injury to yourself if you were to have a big seizure. So certain restrictions we have in terms of that is if you go swimming, we say that you should have a one-on-one supervision. So like if you're at a beach and there's a lifeguard watching a bunch of people, that's not acceptable in terms of supervision. You should have someone on the beach watching you one-to-one directly. So that way, in case you had a seizure on the water, they could be able to pay attention and get you out of there. So that's one big thing.

And driving is a big thing, obviously, too that affects people's lifestyles because if you were having a seizure, you would lose consciousness, you would lose control of the car and not only harm yourself and the people in your car, but also other people on the road. So that's a really, really important precaution we like to stress in patients with epilepsy. So typically we ask them if, you know, they have a driver or take public transportation. It is one of the most difficult lifestyle changes that we find in patients with epilepsy, but it is an important one to follow. That way, you and others are safe.

And then other activities, you know, we kind of say, use your judgment. If you were to have a seizure and it would cause serious harm to yourself or others, you just should be cautious about. So like skydiving isn't one I usually recommend. You shouldn't be scuba diving. So things where, you know, if you were having a seizure, it would be really dangerous to yourself or others.

But the big ones we tell people are the no driving, the no swimming alone, you shouldn't be on heights and ladders, and you shouldn't be operating heavy machinery. Those are the big restrictions we give people when they're diagnosed with epilepsy.

If you have a diagnosis of epilepsy and you've been tried on different medications and are continuing to have seizures for at least more than a year, that you should be seen at an epilepsy center and seen specifically by epileptologists.

And we do have comprehensive care with neurosurgeons, radiologists, neuropsychologists, nurses, social worker. So you will get a lot of resources that you may not get otherwise in terms of other options for treating your epilepsy.

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