Why am I experiencing recurrent seizures despite medication?

Question

Hello doctor,

I have been having seizures since I was 19. They were under control for a few years, but lately I have had a few again, even though I take my medication regularly. I am on Lamotrigine and Levetiracetam. I also have a few concerns:

Could stress or sleep loss be triggering them?
I am worried about driving again. Are there any new treatments, such as surgery or nerve stimulation, that actually reduce seizures long-term? Also, my memory feels foggy lately.
Could that be a side effect of the medication or a symptom of the seizures?

I just want to get back to living a normal life. What steps should I take to manage this?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Yes, stress and lack of sleep are two of the most common seizure triggers, even when medication is taken regularly. Missing meals, dehydration, and hormonal changes can also contribute. Maintaining a fixed sleep schedule, managing stress, and avoiding late nights or missed doses are important, as even small disruptions can lower the seizure threshold.

You are already on two strong anti-seizure medicines, Lamotrigine and Levetiracetam, which work well together for many people. If seizures are still happening, your neurologist may check blood levels, adjust doses, or consider adding newer medicines like Lacosamide, Brivaracetam, or Perampanel for better control.

Mild memory fog can occur due to repeated minor seizures, sleep deprivation, or side effects of Levetiracetam or Lamotrigine. Adjusting doses, improving sleep quality, and engaging in mental exercises often help. If the issue worsens, your doctor can reassess which medicine is the likely cause.

You should avoid driving until you have been seizure-free for 6 to 12 months, depending on local regulations. This is important for your safety and for others on the road. Once stable, your doctor can guide you on when it is safe to resume driving.

If two or more medicines fail to control seizures, it is considered drug-resistant epilepsy. In such cases, other treatments may help:

Vagus nerve stimulation (VNS): A small implant in the chest that sends gentle electrical signals to the brain to reduce seizure frequency.
Responsive neurostimulation (RNS): A device that detects abnormal brain activity and delivers quick electrical pulses to prevent seizures.
Epilepsy surgery: If seizures originate from a single, well-identified area (such as the temporal lobe), removing that focus can lead to major improvement or even long-term seizure freedom.

With proper medication adjustments, healthy lifestyle habits, and the possibility of advanced therapy, many people regain excellent seizure control and live fully independent lives. Keeping a seizure diary, prioritising sleep and stress management, and staying in close follow-up with your neurologist are all important steps, and you are already on the right track.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.