FACTORS CAUSING BREAKTHROUGH SEIZURES IN KNOWN EPILEPTIC PATIENTS TAKING PRESCRIBED ANTI-EPILEPTIC DRUGS REGULARLY

Abstract

Background: Epilepsy is a chronic neurological disorder marked by recurrent unprovoked seizures and remains a major cause of neurological morbidity worldwide. Although anti-epileptic drugs control seizures in many patients, breakthrough seizures may still occur despite regular medication intake. These episodes increase the risk of injury, emergency visits, psychological distress, and reduced quality of life. Identifying preventable triggers is therefore essential for improving seizure control and guiding more comprehensive epilepsy care and counselling in routine practice settings.

Objective: To determine the common factors associated with breakthrough seizures among known epileptic patients taking prescribed anti-epileptic drugs regularly.

Methods: This descriptive cross-sectional study was conducted in the Department of Neurology, CMH, Peshawar, from June 2024 to December 2024. A total of 150 known epileptic patients aged 18–65 years who presented with breakthrough seizures despite regular anti-epileptic drug use were included through non-probability convenience sampling. Patients with new-onset seizures, acute symptomatic seizures, poor medication adherence, pregnancy, or significant uncontrolled comorbidities were excluded. Data were collected using a structured questionnaire, medical record review, clinical examination, and relevant investigations. Demographic characteristics, duration of epilepsy, seizure type, anti-epileptic drug regimen, precipitating factors, laboratory findings, EEG, and neuroimaging findings were recorded. Data were analyzed using SPSS version 25, with frequencies, percentages, mean, standard deviation, and chi-square test where applicable.

Results: The mean age was 34.7 ± 12.5 years. Among 150 patients, 90 were male and 60 were female. Generalized tonic-clonic seizures were reported in 90 patients, focal seizures in 45, and absence seizures in 15. Polytherapy was used by 85 patients, while 65 were on monotherapy. Sleep deprivation was identified in 45 patients, infection or fever in 37, psychological stress in 30, drug interaction in 30, missed medication in 20, and metabolic disturbance in 12. Abnormal EEG findings were observed in 22 patients, elevated white blood cell count in 15, liver enzyme elevation in 12, hyponatremia in 8, hypokalemia in 5, and minor nonspecific CT/MRI changes in 7 patients.

Conclusion: Breakthrough seizures among patients taking anti-epileptic drugs regularly were associated with multiple modifiable factors. Routine assessment of sleep, infection, stress, metabolic status, and medication interactions may improve seizure control and support more holistic epilepsy management.

Keywords: Anticonvulsants; Drug Interactions; Epilepsy; Fever; Medication Adherence; Psychological Stress; Sleep Deprivation.