What lifestyle modifications should I recommend to a patient with epilepsy to help reduce seizure frequency?

To help reduce the frequency of seizures, you should recommend the following lifestyle modifications to a patient with epilepsy:

• Adherence to Medication: Support the patient to take their antiseizure medications as prescribed, as uncontrolled seizures increase the risk of epilepsy-related death ¹. Emphasise the importance of compliance to reduce the risk of seizures and sudden unexpected death in epilepsy (SUDEP) ². Non-adherence to medication is a potentially modifiable risk factor for SUDEP ¹.
• Avoidance of Alcohol and Drug Misuse: Advise against alcohol and drug misuse, as these are identified as potentially modifiable risk factors for SUDEP, which is associated with uncontrolled seizures ¹.
• Sleep Management and Supervision: For patients who experience seizures during sleep, discuss the risk of SUDEP and provide information on minimising risks, including taking medication as prescribed ¹. Consider discussing the possibility of introducing or increasing night-time supervision, such as using a night monitor, especially for those assessed to be at higher risk of epilepsy-related death ¹. Sleeping alone without supervision is a modifiable risk factor for SUDEP ¹.
• Ketogenic Diet: For people with certain childhood-onset epilepsy syndromes or drug-resistant epilepsy where other treatments have been unsuccessful or are not appropriate, a ketogenic diet may be considered under the guidance of a tertiary epilepsy specialist ¹.