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

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

3.  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

4.  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

5.  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

6.  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

7.  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

8.  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

9.  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

10.  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

11.  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.

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

13.  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.

14.  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.

15.  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

16.  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.

17.  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

18.  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.

19.  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.

20. 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).

21. *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.

22.  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).

23.  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.

24.  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.

25.  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.

26.  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.

27. 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.

28.  Everyone needs to have an identified means to
relax
 Biofeedback
 Meditation
 Exercise
 Reading
 Knitting/gardening/other hobbies
 Relaxation reduces stress and improves well-
being.

29. Artificial sweeteners, FDA at:
10903 New Hampshire Avenue, Silver Spring, MD 20993 1–888–INFO–FDA
http://www.fda.gov/
Valproic acid and Carnitine Valproate-associated Hyperammonemic Encephalopathy
http://www.jabfm.org/content/20/5/499.full
Sleep deprivation and epilepsy
http://www.epilepsy.com/epilepsy/provoke_sleepdep - 430k
Exercise and epilepsy
http://professionals.epilepsy.com/page/Exercise_and_Epilepsy.html - 43k
http://www.epilepsyfoundation.org/livingwithepilepsy/healthandwellness/stayinghealthy/p
hysicalfitness.cfm - 39k -