What lifestyle changes help in the management of epilepsy?

Question

Hello doctor,

I am a 32-year-old male, and I have been living with epilepsy since I was 14. I usually get generalized tonic–clonic seizures about once every two to three months, even though I take Sodium Valproate 500 mg twice daily and Levetiracetam 750 mg at night. My last EEG showed abnormal epileptiform discharges in the left temporal lobe, and my MRI brain showed a small area of mesial temporal sclerosis.

Recently, I was also diagnosed with hypertension, and my average blood pressure readings are around 150/92 mmHg despite starting Amlodipine. My lipid profile showed total cholesterol at 235 mg/dL and triglycerides 205 mg/dL. I often feel very fatigued and sleepy, especially after seizures, and sometimes have memory lapses.

My recent liver function tests showed ALT 62 U/L, which my doctor said could be due to Valproate. My hemoglobin was 12.1 g/dL, and fasting blood sugar was 118 mg/dL, putting me in the prediabetic range. The combination of seizures, high BP, and weight gain, I now weigh 55 pounds with a BMI of 29, worries me about long-term health risks. I also get headaches and dizziness before some seizures, which makes me anxious in public.

I want to know if I should change or add to my current epilepsy medicines, considering the liver enzyme rise. Also, do my hypertension or borderline sugars increase seizure risk or medication side effects? Lastly, what lifestyle steps, like diet, exercise, or stress management, can help me manage both epilepsy and my heart health together?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

You are dealing with a lot and thinking very carefully about your long-term health, which is the most important first step. Let us break this down together in a straightforward way.

First of all, it is completely understandable why you are worried. You are juggling multiple health issues, and it feels like they are all connected. Your approach of wanting to tackle this holistically, looking at medicines, lifestyle, and the bigger picture, is exactly right.

Here is a look at your questions, and your doctor is correct that the mildly elevated ALT (alanine aminotransferase) liver enzyme is a known potential side effect of Sodium Valproate. It is something that needs monitoring, but a level of 62 U/L(microliter) is often managed with watchful waiting rather than immediate panic.

However, the combination of this with your weight gain, feeling fatigued, and the prediabetes is a significant clue. Valproate is well-known for causing weight gain and can contribute to insulin resistance (which leads to higher blood sugar) and raised cholesterol. It can also be sedating, adding to your fatigue.

Should you change or add any medicines? This is a crucial conversation to have with your neurologist. It is very reasonable to discuss the pros and cons of switching from Valproate to another medication that is less likely to cause these metabolic issues. There are several other excellent anti-seizure medications (ASMs) that are weight-neutral or even promote weight loss. Given your history of mesial temporal sclerosis, certain ASMs might be particularly suitable. Do not stop or change your dose on your own, but definitely book an appointment to explore this with your doctor.

Directly: Neither high blood pressure nor slightly high blood sugar is a common direct trigger for a seizure in most people with epilepsy.

Indirectly: Absolutely yes, they are connected. Here is how:

Overall health: Both conditions contribute to poor blood vessel health and inflammation in the body. This overall state of stress on your body can lower your seizure threshold, making it easier for a seizure to occur.
Sleep: Uncontrolled hypertension can affect sleep quality. Poor sleep is one of the most common and powerful triggers for seizures.
Medication side effects: Some blood pressure medications can cause dizziness. You mentioned you get dizzy before seizures; it is important to figure out if the dizziness is a seizure warning (an aura) or a side effect from the Amlodipine.

The beautiful part is that the same healthy habits help all your conditions at once.

1. Diet:

Focus on whole foods: Think vegetables, lean proteins, and whole grains (oats, quinoa, brown rice). This helps with weight, blood sugar, cholesterol, and overall health.
Reduce processed carbs and sugar: This is key for your prediabetes and triglycerides. Reduce your intake of sugary drinks, white bread, pasta, and snacks.
Consider a structured approach: A diet like the Mediterranean diet is fantastic because it is proven to help with heart health, weight, and blood sugar. Some people also find that very low-carb diets (like keto) help with seizure control, but this is a major step that must be done under medical supervision, especially with your other health factors.

2. Exercise:

Start slow and be consistent: You do not need to run a marathon. Brisk walking for 30 minutes a day, five days a week, will make a huge difference. It helps lower blood pressure, improves insulin sensitivity, aids weight loss, and is a powerful stress reducer.
Safety first: If you have seizures frequently, avoid high-risk activities like swimming alone or heavy weightlifting without a spotter. Stick to activities like walking, stationary biking, or group classes where someone is aware. This is non-negotiable for seizure control. Your anxiety in public is understandable.
Prioritize sleep: Aim for seven to eight hours of quality sleep per night. Create a calming bedtime routine.
Practice stress reduction: Even 10 minutes a day of deep breathing, mindfulness, or meditation can calm your nervous system. This can help reduce the anxiety that might contribute to your seizures.

I hope this information will help you.

Kindly follow up if you have more concerns.

Thank you.