How can I effectively counsel patients with temporal lobe epilepsy about lifestyle modifications to reduce seizure frequency?

To effectively counsel patients with temporal lobe epilepsy regarding lifestyle modifications to reduce seizure frequency, focus on key areas that directly impact seizure control and overall well-being. It is crucial to develop an individualised treatment strategy that considers personal circumstances, including alcohol use and travel ¹.

• Medication Adherence: Strongly support patients to take their antiseizure medications as prescribed to reduce seizures ¹. Explain that uncontrolled seizures, particularly generalised tonic-clonic seizures or focal to bilateral tonic-clonic seizures, increase the risk of epilepsy-related death ¹. Discuss adherence strategies and coping mechanisms for side effects ¹.
• Avoidance of Alcohol and Drug Misuse: Counsel patients that alcohol and drug misuse are potentially modifiable risk factors for sudden unexpected death in epilepsy (SUDEP) and can impact seizure control ¹.
• Safety and Supervision: Discuss the possibility of introducing or increasing night-time supervision, for example, using a night monitor for individuals with seizures during sleep who are at higher risk of epilepsy-related death ¹. Provide information on minimising risks, including taking medication as prescribed ¹.
• Driving Regulations: Inform patients about Driver and Vehicle Licensing Agency (DVLA) regulations related to epilepsy ¹.
• Mental Health and Well-being: Be aware that people with epilepsy have a higher prevalence of mental health difficulties, such as depression and anxiety ¹. Addressing emotional health and psychological well-being can indirectly support overall seizure management ¹.
• Reproductive Health: Provide support and information on contraception and pregnancy to enable informed decision-making, including potential interactions with antiseizure medications and pre-conception planning ¹.
• Emergency Planning: Agree on an individualised emergency management plan with the person if they experience repeated, cluster, or prolonged seizures and there is concern about recurrence ¹.