Clinician’s Corner: Healthy Lifestyles and the Impact of Wellness on Epilepsy

- Clinician's Corner

By Dr. Jason Doescher, Minnesota Epilepsy Group

This article is the second in a three-part series highlighting the Epilepsy Foundation’s wellness initiative.  Part 1 featured an outline of a general healthy lifestyle, identified choices made within each element, and reinforced how consistent behavioral habits impact a person’s health. This section, Part 2, focuses more specifically on wellness for individuals with epilepsy and how each element might impact the condition. Part 3 will then focus on the health and well-being of a caregiver recognizing the challenges for self-care inherit with that role. 

The Epilepsy Foundation’s Wellness Institute recognizes these eight discrete aspects contributing to well-being:

  • Emotional Health
  • Stress Management
  • Sleep
  • Diet & Nutrition
  • Physical Activity
  • Independent Living
  • Social Relationships
  • Education & Employment 

Importantly, each person has unique characteristics and qualities, likes and dislikes, and abilities. This article reviews some common themes related to how healthy lifestyle habits can influence the condition and management of epilepsy, however, an individual’s practice and response will be unique. This should be used as a guide to discuss with your medical care team, focusing on current habits and how changes can be incorporated in a personal care plan under the direction of a physician.  

Sleep

Sleep offers rest and recovery to the body and brain. Most people feel well with 7-9 hours of uninterrupted sleep; however, attention to a person’s energy level and mood may suggest more sleep is necessary. Sleep disordered breathing, which includes sleep apnea, disrupt both the quantity and quality of sleep, and is a common cause of excess fatigue. Sleep deprivation, fatigue, and normal transitions in and out of sleep have been associated with lowering of an individual’s seizure threshold. 

Many anti-epileptic drugs have side effects of fatigue which can make these risks more common, while other medications may disrupt normal sleep cycles. Both focal and generalized epilepsies, such as childhood absence and juvenile myoclonic epilepsy, may have increased risk of seizures and abnormal epileptiform activity with sleep deprivation. Patients with epilepsy should establish a regular sleep routine and their change habits if not getting effective rest. 

Melatonin is a commonly utilized supplement noted to regulate sleep-wave cycles and is being investigated for potential anti-epilepsy properties particularly for children. Melatonin may have negative effects as reported for individuals with temporal lobe epilepsy or epilepsy with developmental disabilities, thus involving doctor’s advice is necessary. While Vagus Nerve Stimulation (VNS) has been reported to reduce daytime sleepiness at low stimulation settings, this therapy has also been associated with risk of nocturnal obstructive sleep apnea resulting in significant fatigue. Sleep questions or concerns should be discussed with a person’s medical team. When it comes to sleep, individuals with epilepsy should have a regular bedtime routine and discuss sleep and daytime energy levels at every doctor’s visit

Nutrition

A diet’s impact on seizures has been recognized for thousands of years. The practice of periodic fasting evolved to the therapeutic ketogenic diet, as well as other metabolic treatments such as low glycemic index treatment and modified Atkins diet. More recently, whole foods and healthy diet habits have become key lifestyle measures reducing inflammation and preventing some chronic diseases.  A dietitian has become a key member of an epilepsy treatment team. 

While the ketogenic diet is a specific therapy with risks and benefits that should be applied under a physician’s direction and dietitian’s consultation, it may provide the best therapy for certain intractable epilepsies. Attention to other nutritional elements such as vitamin D and calcium levels is important as deficiency is common among people with epilepsy. Healthy diets support brain development across a lifetime; healthy diets are key to preventing degenerative disease such as Alzheimer’s disease, stroke, and vascular dementia which can associate with seizures. People with epilepsy benefit from making healthy foods a consistent part of their lifestyle habits and consulting a dietitian to improve their daily routine.    

Physical Activity

While fitness and activity are well established elements of health, the impact on epilepsy is less clear. More recent research supports enhanced physical activity as beneficial for both body as well as social and emotional health. Scheduled physical activity was associated with benefits to daily function and reduced disability, as well as improved attitude, confidence, and insight to health. 

This knowledge is important as studies reflect one third of people with epilepsy were sedentary or irregularly active, which had a negative association with quality of life and poor emotional health. Some individuals restrict activity for ability related safety reasons or limit behavior due to fear of seizures. Research supports that exhaustive exercise is not a common seizure inducting factor. 

Working with a person’s medical team, people with epilepsy can help set reasonable targets and problem solve risks. Speaking with a physical therapist or personal fitness trainer may be valuable if physical adaptions are needed or to answer questions. Setting step goals and walking with family and friends may be an easy initial and valuable part of a daily routine with positive impacts on physical, social, and emotional health.  

Emotional Health, Stress Management and Social Relationships

Like many complex chronic conditions, particularly individuals with intractable epilepsy, managing emotional health is a challenge and recognized limitation on quality of life. This underscores the need to take a proactive approach and utilize the necessary resources to make positive social support, personal growth or hobbies, and rewarding events a scheduled part of life.  An improving quality of life is the overall goal, so make positive experiences regular events!  

Higher psychological stress can increase seizure risk or frequency. Patients with epilepsy should discus their mood, feeling, fears, self-care habits, and community resources with their doctor. Adolescents and older people are particularly vulnerable as well as those in other transition periods of life. Health care professionals should actively inquire about health of relationships, memory, and physical complaints in patients as these elements strongly correlate with quality of life in an intractable epilepsy group. 

Often, a clinical psychologist is a key epilepsy care team member, and the benefits serve not just the patient, but also the extended family and friends. Build a team of experts to guide choices and problem solve obstacles.

Education and Employment

In patients with epilepsy, continual education, meaningful employment, and self-management practices can reduce seizure frequency, improve quality of life, improve medication adherence, and reduce accidental injury. The Epilepsy Foundation is the national, regional, and local resource to learn more and find additional support. As noted in this article, dietitians, physical therapists, clinical psychologists are key resources for consultation. Additionally, pharmacists can educate on medications and help identify negative drug interactions. Social workers can help navigate the complex system of available resources through different life stages. 

Every person with epilepsy is an individual who deserves an improving quality of life. Incorporating healthy lifestyle habits into a medical plan and making them intentional, regular daily activities will have positive results. While each life and path are unique, everyone benefits from using available expertise, planning specific goals, and changing for the better by investing in a healthy lifestyle. Find ways to get better and more consistent sleep, eat a nutritious whole foods diet, get daily physical activity, be social, develop hobbies, and stay educated on epilepsy and healthy lifestyle activities. Use the Epilepsy Foundations Wellness program to better manage seizures, invest in whole person health, and improve each day.

References:  

Sleep:

Y-Qun Wang et al. The Mutual Interaction Between Sleep and Epilepsy on the Neurobiological Basis and Therapy. Current Neuropharmacology, 2018, 16, 5-16.

Nutrition:

Jésus P, Godet B, Darthou-Pouchard L, Fayemendy P, Abdallah-Lebeau F, Villeneuve O, Marcon C, Gimenez L, Preux PM, Couratier P, Desport JC. Vitamin D status among patients with drug-resistant and non-drug-resistant epilepsy. Int J Vitam Nutr Res. 2020 Jun;90(3-4):205-209. doi: 10.1024/0300-9831/a000459. Epub 2020 Mar 13. PMID: 32167416.

Adam L. HartmanEileen P. G. Vining. Clinical Aspects of the Ketogenic Diet. Epilepsia Volume48, Issue1 January 2007 Pages 31-42

Fitness:

Jessica Willis et al., Youth with epilepsy: Their insight into participating in enhanced physical activity study. Epilepsy & Behavior, VOLUME 89, P63-69, DECEMBER 01, 2018

Physical activity, stigma, and quality of life in patients with epilepsy. G. Tedrus and Guilherme Sabbag Sterca and Renato Buarque Pereira, Epilepsy & Behavior. 2017 volume 77,96-98.

Vancini, R., C. A. B. Lira, F. Scorza, M. Albuquerque and R. Arida. “Cardiorespiratory and electroencephalographic responses to exhaustive acute physical exercise in people with temporal lobe epilepsy.” Epilepsy & Behavior 19 (2010): 504-508.

Emotional Health:

Lu, Bo and J. Elliott. “Beyond seizures and medications: Normal activity limitations, social support, and mental health in epilepsy.” Epilepsia 53 (2012): n. pag.

Loring, D., K. Meador and Gregory P. Lee. “Determinants of quality of life in epilepsy.” Epilepsy & Behavior 5 (2004): 976-980.

Cano-López, I., K. Hampel, M. Garcés, V. Villanueva and E. González-Bono. “Quality of life in drug-resistant epilepsy: relationships with negative affectivity, memory, somatic symptoms and social support.” Journal of psychosomatic research 114 (2018): 31-37 .

Education:

Hu, M., Chenqi Zhang, Xiao-qiang Xiao, Jiang Guo and H. Sun. “Effect of intensive self-management education on seizure frequency and quality of life in epilepsy patients with prodromes or precipitating factors.” Seizure 78 (2020): 38-42.