What lifestyle modifications should I recommend to a patient with epil

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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 . Emphasise the importance of compliance to reduce the risk of seizures and sudden unexpected death in epilepsy (SUDEP) . Non-adherence to medication is a potentially modifiable risk factor for SUDEP .
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 .
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 . 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 . Sleeping alone without supervision is a modifiable risk factor for SUDEP .
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 .

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