Joyce Liporace, M.D.May 4th, 2013

Avoiding triggers for seizures Maintain a healthy weight Nutrition-Healthy diet, Vitamins/Minerals Hydration Sleep Exercise Don’t smoke Relaxation

In most cases, seizures are random events but they can be influenced by our environment

Inadequate or fragmented sleep Alcohol ingestion Flashing lights Stress Hormones Head trauma

Eat a balanced diet with a variety of healthy foods Adults should eat no more than 70 grams of fat a day Avoid trans fats/saturated fats. Increase intake of

omega 3 fats. Cook with mono-unsaturated fats (olive oil, sunflower oil) or polyunsaturated fats (safflower oil)

Eat “complex carbohydrates”-whole wheat, brown rice. Eat enough protein-found in meat and fish but also

nuts, seeds, lentils and beans Eat regular meals

Know your Body Mass Index (BMI)-a measure calculated from your height and weight

Formula: weight (lb) / [height (in)]2 x 703 Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multiplying by a conversion factor of 703.

Calculation tools on line

Normal BMI is 18.5 to 24.9 Underweight < 18.5 Overweight 25-29.9 Obese >30

Example: Weight = 150 lbs, Height = 5'5" (65")BMI Calculation: [150 ÷ (65)2] x 703 = 24.96

Special high fat, no sugar, low protein diet to mimic the effects of starvation (body burns fat instead of glucose)

Carbohydrates are strictly limited Typical dinner: chicken cutlet, broccoli with

cheese, lettuce with mayo and a whipped cream sundae

Need regular monitoring by a doctor and nutritionist to avoid serious side effects

Difficult to maintain-requires discipline Cheating/deviation can lead to seizures Need to monitor everything-toothpaste has

sugar, some sunscreens contain sorbitol which can be absorbed through the skin

Some people find benefit with low glycemic index diet or Atkins diet

Speak with your doctor about it

Complicated question-many people try to avoid monosodium glutamate (MSG), refined sugars, artificial sweeteners, glutamate, cured meats

Avoid excessive caffeine Soy is plant estrogen (tofu, soymilk, miso,

soybeans) Alcohol Energy drinks

Found in many foods and beverages 1.5 Billion dollar industry Confusing-many names for same products Aspatame is Equal is Nutrasweet is

Aminosweet Saccharin is Sweet’N Low Many health concerns-cancer, dizziness,

memory decline-none of these are confirmed

Composed of two amino acids (phenyalanine and aspartic acid) along with methyl ester.

Methyl ester is metabolized to methanol-a know toxin.

Methanol spontaneously breaks down to formaldehyde-another known toxin.

It was first sold under the brand name NutraSweet; since 2009 it also has been sold under the brand name AminoSweet.

Essential nutrients that your body needs in small amounts to work properly

Disturbances in some minerals (calcium, magnesium or sodium) can cause seizures (even in people without epilepsy).

Some seizure medications cause low sodium-Carbamazepine, Oxcarbazepine.

Fat soluble seco-steroid responsible for intestinal absorption of calcium and phosphate

Main source is sunlight-our skin makes Vitamin D (so technically it’s not a vitamin)

Found in fish oils/flesh, supplemented milk, mushrooms

Essential for bone health. May lower the risk of heart attacks and stroke. Studies suggest other health benefits.

Many of us are not getting adequate Vitamin D

Vitamin D can be measured in your blood Adequate level 25-hydroxy Vit D is between

30-100 Vitamin D toxicity is rare but it can occur-it

is a fat soluble vitamin and you can ingest too much of it.

Several forms of Vitamin D exist-our skin make Vitamin D3

Ask your doctor to check your 25-hydroxy Vitamin D level

If it is below 30, you need a supplement If it is below 20, you may need a large

weekly supplement for a few weeks If you are on Vitamin D replacement, you

need your level checked periodically.

Optimal intake of calcium for most adults is 1,200 to 1,800 mg each day

It cannot be absorbed without vitamin D You can only absorb 600 mg of calcium at a time New studies state that we should get calcium from diet

only and avoid supplements

Biosynthesized from amino acids Required for transport of fatty acids into

mitochondria to generate metabolic energy. Deficiency has been linked with high

ammonia levels, especially with use of Depakote (Valproic Acid)

Many people will feel better with Carnitine supplement, especially those on Depakote with a high ammonia level.

Your body depends on water for survival. Water makes up more than half your body weight.

Most people have been told they should be drinking 6 to 8 eight ounce glasses of water each day, which is a reasonable goal. However, different people need different amounts of water to stay hydrated.

If you are concerned that you may not be drinking enough water, check your urine. If your urine is consistently colorless or light yellow, you are staying well hydrated.

Many adults are not drinking enough water Taking in too little water or losing too much

water leads to dehydration. Symptoms of mild dehydration include thirst, dark urine, pains in joints and muscles, headaches and constipation.

Some seizure medications can increase the risk of kidney stones if you do not stay hydrated (Topiramate, Zonisamide).

*Keep a bottle of water with you during the day.

*Carry a reusable water bottle.* If plain water doesn’t interest you, try

adding a slice of lemon or lime to your drink.

* With exercise, drink water before, during and after your workout.

* Start and end your day with a glass of water.

Drinking too much water can lower your sodium (hyponatremia) to dangerous levels and lead to seizures.

This can be a real problem when you are taking medications that lower sodium-Tegretol/Carbatrol (Carbamazepine) or Trileptal (Oxcarbazepine).

Sleep deprivation may trigger seizures-the chance of having a seizure after a night with sleep deprivation is higher compared to a good night’s sleep

Most adults require 8 hours of sleep a night, children require more sleep

Practice good sleep “hygiene” Consider getting a sleep study if you wake

up feeling tired, you snore or you have restless sleep.

Sleep deprivation can increase abnormalities on your EEG-more spikes and sharp waves, often used to help with diagnosis

Some people have more seizures during sleep-most common with frontal lobe epilepsy

Nocturnal seizures occur most often during non-REM, non slow wave sleep. It’s rare for seizures to happen during REM sleep.

Promotes general health, improves bone density, lowers BP, relieves stress, reduces depression

It is rare for exercise to cause seizures-caution with hyperventilation or getting overheated.

Need to be safe when exercising-supervised, avoid treadmills. Caution with swimming, rock climbing, scuba diving.

Each individual must make a decision about accepting the risk of seizures during exercise.

For example, long distance runners sometimes accept the risk of having a seizure while running alone. Everyone should try to minimize their risk.

Recommendations regarding contact sports have changed over the years-from avoidance to encouragement. Recurrent head trauma can worsen seizures. Apply common sense.

Smoking contributes to the death of approximately 500,000 people each year from heart disease, stroke, and cancer.

Smoking tobacco is not known to have any effects on seizure control, but persons with epilepsy are susceptible to all the usual effects of smoking and an increased risk of injury or death from fire.

Talk to your doctor about smoking cessation.

Everyone needs to have an identified means to relax

Biofeedback Meditation Exercise Reading Knitting/gardening/other hobbies Relaxation reduces stress and improves

well-being.

Artificial sweeteners, FDA at:10903 New Hampshire Avenue, Silver Spring, MD 20993 1–888–INFO–FDAhttp://www.fda.gov/

Valproic acid and Carnitine Valproate-associated Hyperammonemic Encephalopathyhttp://www.jabfm.org/content/20/5/499.full

Sleep deprivation and epilepsy http://www.epilepsy.com/epilepsy/provoke_sleepdep - 430k

Exercise and epilepsyhttp://professionals.epilepsy.com/page/Exercise_and_Epilepsy.html - 43khttp://www.epilepsyfoundation.org/livingwithepilepsy/healthandwellness/stayinghealthy/physicalfitness.cfm - 39k -