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When a person experiences a seizure after being seizure-free for a while through treatment, it’s called a breakthrough seizure. Studies in the field of neurology show that approximately 70 percent of people with epilepsy will go into remission from seizures, typically with the help of treatment. Of those who achieve remission, approximately 37 percent will experience a breakthrough seizure, according to some research. However, other studies have shown breakthrough seizure rates to be as high as 75 percent and as low as 20 percent

Breakthrough seizures are normal for people with generalized seizures or other types of epilepsy. However, understanding why breakthrough seizures happen and what can be done to prevent them can help a person with epilepsy improve their quality of life.

What Do Breakthrough Seizures Indicate?

Breakthrough seizures can indicate a few things, including the possibility that someone has not been taking their antiseizure medication as prescribed.

A study from the journal Neurosurgery showed that the biggest predictors of breakthrough seizures were:

• Missed doses of prescribed medication — 56.4 percent
• Sleep deprivation — 36.4 percent
• Psychological stress — 34.5 percent

A study from the journal PLOS One noted that alcohol, drug use, television, and video games are also linked to breakthrough seizures.

Seizure history can also be a significant predictor of a person’s risk of breakthrough seizures. The more tonic-clonic seizures a person has had before achieving remission, the more likely they are to have a breakthrough seizure while on treatment.

If it takes a person more than one year to achieve a seizure-freedom period, then they’re at a higher risk of experiencing a breakthrough seizure. Similarly, if a person’s seizures require more than one medication to help them achieve seizure control, they are at greater risk. People with learning disabilities or known impairments in their neurological function also have a higher likelihood of breakthrough seizures.

In some cases, a person may experience a breakthrough seizure just once. In other cases, a person’s seizures may become recurrent again. One study showed that 63 percent of individuals who had their first breakthrough seizure went on to have seizure recurrence. This same study also found that gender was also a risk factor for breakthrough seizures — men are more likely to achieve 12-month seizure remission than women.

The biology to explain this phenomenon is not yet understood. One hypothesis is that men are possibly not reporting seizures as frequently as women, so as not to affect employment. Nevertheless, women may be still more likely than men to experience breakthrough seizures.

Next Steps After Breakthrough Seizures

If someone is taking their medication as prescribed and is experiencing breakthrough seizures, their doctor may attempt to change their medication regimen. However, if the breakthrough seizures are a result of a person not sticking to their treatment plan, the doctor may have a serious discussion with them about the importance of doing so.

For people who experience breakthrough seizures as a result of other factors, it can be important to reduce stress levels and get adequate sleep. Learning to use coping skills or taking part in psychological counseling also can be helpful.

Limiting alcohol intake is especially important in people who have seizures. Binge drinking and withdrawal from alcohol can cause life-threatening seizures, including a condition known as status epilepticus. Status epilepticus is defined as a prolonged seizure or multiple seizures within a short time period in which the person does not fully recover between those seizures or return to their neurological baseline. Additionally, antiepileptic drugs (AEDs) can lower alcohol tolerance, which means a person will feel intoxicated on less alcohol than they would normally consume.

Reviewing a list of medications you take for other medical problems with your primary care physician and neurologist is also important. Some drug interactions occur with AEDs or can lower what’s called the “seizure threshold,” putting you at greater risk of experiencing a seizure or other side effects.

Treating Breakthrough Seizures

Breakthrough seizures are treated similarly to other epileptic seizures. AEDs or antiseizure medications are the first line of defense in epilepsy and include:

• Valproate (sold as Depacon)
• Levetiracetam (Keppra and Elepsia XR)
• Lamotrigine (Lamictal)
• Topiramate (Qudexy XR, Topamax, and Trokendi XR)
• Phenytoin (Dilantin and Phentytek)
• Carbamazepine

Benzodiazepines or anti-anxiety medications also have a place in treating seizures, including breakthrough seizures.

If a doctor makes any changes to your medication prescription regimen or epilepsy management, it is important to ensure that your other health care providers are aware. This includes:

• The emergency room doctor who may be the first to see you after a breakthrough seizure
• Your primary care doctor
• Your neurologist who is primarily managing your epilepsy
• Any other relevant clinicians

Not everyone responds in the same way to the same medication, as we all have our own unique brain and body chemistry. Many people need to try several drug treatments or drug therapies, including different dosages, to become seizure-free. Some people need to take a combination of seizure medications to achieve remission.

In one study, 44 percent of people with epilepsy did not respond to their first treatment. However, 75 percent of these individuals achieved 12-month remission within six years of follow-up. As such, a large number of people achieve some form of seizure control and do not experience true refractory epilepsy.

Once you find something that works for you, stick with it.

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