Epilepsy

Epilepsy is a tendency to recurrent unprovoked seizures arising from abnormal synchronous cortical activity. Around two thirds of people achieve good control with anti-seizure medication, and the central rule of self-management is that adherence matters more than anything else: missed doses are one of the most common triggers for breakthrough seizures, alongside sleep deprivation, alcohol withdrawal and, in a minority, photic stimulation. Nutrition enters the picture in three defensible ways. First, long-term enzyme-inducing drugs such as carbamazepine, phenytoin and phenobarbital accelerate vitamin D metabolism and are associated with reduced bone density, so periodic vitamin D testing and repletion is standard practice. Second, valproate and phenytoin interfere with folate, which matters greatly for anyone who could become pregnant — high-dose folic acid before conception is a specialist decision, and valproate carries substantial teratogenic risk. Third, ketogenic and modified Atkins diets have real randomised evidence in drug-resistant epilepsy, particularly in children, but they are medical therapies requiring dietitian supervision, not something to attempt informally. Several popular botanicals cut the other way: high-dose evening primrose oil, ginkgo and ephedra have been associated with lowered seizure threshold, and St John's wort induces the enzymes that clear many anti-seizure drugs.

• •Convulsive seizures with loss of consciousness
• •Brief blank staring episodes
• •Focal twitching or sensory disturbance
• •Aura such as rising epigastric sensation or déjà vu
• •Post-ictal confusion and fatigue
• •Tongue biting or incontinence during an event

• •Genetic epilepsy syndromes
• •Post-stroke or post-traumatic scarring
• •Hippocampal sclerosis
• •Brain tumour or malformation
• •Previous CNS infection
• •Autoimmune encephalitis

Genetic generalised epilepsy syndromes, structural lesions from stroke, trauma, tumour or malformation, hippocampal sclerosis, CNS infection, autoimmune encephalitis, and in many adults no identifiable cause. Breakthrough seizures are commonly provoked by missed medication, sleep loss and alcohol.