Seizure and dehydration. Dehydration in Epilepsy: Exploring the Therapeutic Effects and Clinical Applications

18.08.202315.06.2023 by alexxlab

How does dehydration affect epilepsy. What are the historical and scientific foundations for using fluid restriction in epilepsy treatment. Can dehydration therapy improve seizure control in epileptic patients. What are the potential risks and benefits of dehydration therapy for epilepsy.

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The Historical Context of Dehydration Therapy in Epilepsy

The use of dehydration as a therapeutic approach for epilepsy has roots dating back to the early 20th century. Dr. Temple Fay is credited with pioneering the clinical application of restricted fluid intake for epilepsy treatment, although some reports suggest earlier usage by Hartenberg as far back as 1913. This innovative approach was developed based on several key observations and research findings:

Increased cerebrospinal fluid collections in epileptic patients, as observed by surgeons, pathologists, and radiologists using encephalography
Experimental studies showing that excessive fluid intake predisposed animals to convulsions
Research by Gamble demonstrating a tendency for fluid retention prior to seizures
McQuarrie’s work establishing a parallel between hydration levels and increased seizure activity

These foundational studies laid the groundwork for exploring dehydration as a potential therapeutic intervention for epilepsy management.

Scientific Basis for Dehydration Therapy in Epilepsy

The scientific rationale behind dehydration therapy in epilepsy is multifaceted, encompassing both physiological and neurological aspects:

Cerebrospinal Fluid Dynamics

Increased cerebrospinal fluid (CSF) volumes observed in epileptic patients suggested a potential link between fluid balance and seizure activity. By reducing overall fluid intake, researchers hypothesized that CSF volumes could be modulated, potentially influencing seizure thresholds.

Electrolyte Balance and Neuronal Excitability

Dehydration therapy may affect electrolyte concentrations in the brain, potentially altering neuronal excitability. Changes in extracellular ion concentrations, particularly sodium and chloride, can influence the likelihood of neuronal firing and seizure propagation.

Metabolic Effects

Restricted fluid intake may induce metabolic changes that could impact seizure susceptibility. These changes might include alterations in glucose metabolism, ketone production, or other metabolic pathways that influence brain function and seizure thresholds.

Clinical Applications and Outcomes of Dehydration Therapy

Dr. Fay’s groundbreaking study in 1931 provided the first substantial clinical evidence for the efficacy of dehydration therapy in epilepsy. His research, involving 23 epileptic patients, yielded promising results:

Approximately 60% of patients showed definite improvement in seizure control
The therapy demonstrated potential as a non-pharmacological approach to epilepsy management
Results suggested that fluid restriction could be a viable adjunctive treatment for some epileptic patients

These findings sparked interest in the medical community and paved the way for further investigations into the therapeutic potential of dehydration in epilepsy treatment.

Mechanisms of Action in Dehydration Therapy for Epilepsy

Understanding the precise mechanisms by which dehydration therapy influences seizure activity is crucial for optimizing its clinical application. Several potential pathways have been proposed:

Neuronal Hyperexcitability Reduction

Dehydration may decrease neuronal hyperexcitability by altering the extracellular environment. Reduced fluid volumes could lead to changes in ion concentrations, potentially raising the threshold for neuronal firing and reducing the likelihood of seizure initiation.

Blood-Brain Barrier Permeability

Fluid restriction might influence blood-brain barrier permeability, affecting the movement of substances between the bloodstream and the brain. This could impact the delivery of antiepileptic medications or the clearance of metabolites that influence seizure activity.

Neurotransmitter Balance

Dehydration therapy may induce changes in neurotransmitter systems, potentially altering the balance between excitatory and inhibitory neurotransmission. This could have implications for seizure threshold and propagation.

Potential Risks and Considerations in Dehydration Therapy

While dehydration therapy shows promise in epilepsy management, it is not without potential risks and considerations:

Electrolyte imbalances: Severe fluid restriction can lead to dangerous electrolyte disturbances
Cognitive impairment: Dehydration may affect cognitive function and mental clarity
Kidney stress: Prolonged fluid restriction could place additional stress on renal function
Cardiovascular effects: Dehydration may impact blood pressure and cardiovascular health
Individual variability: Response to dehydration therapy can vary significantly among patients

These factors underscore the importance of careful monitoring and individualized approach when implementing dehydration therapy for epilepsy.

Modern Perspectives on Dehydration Therapy in Epilepsy Management

Contemporary epilepsy research has continued to explore the potential of dehydration therapy, albeit with a more nuanced understanding:

Targeted Fluid Restriction

Rather than general dehydration, modern approaches often focus on targeted fluid restriction, aiming to achieve specific physiological effects without risking severe dehydration.

Combination Therapies

Dehydration therapy is now often considered as part of a comprehensive treatment plan, potentially complementing pharmacological interventions and other non-drug therapies.

Personalized Medicine Approach

Advances in genetic and metabolic profiling allow for a more personalized approach to dehydration therapy, tailoring fluid restriction protocols to individual patient characteristics and seizure patterns.

Future Directions in Dehydration-Based Epilepsy Research

The field of epilepsy research continues to evolve, with several promising avenues for future investigation related to dehydration therapy:

Advanced neuroimaging studies to elucidate the effects of controlled dehydration on brain structure and function in epileptic patients
Development of precise biomarkers to predict individual responsiveness to dehydration therapy
Investigation of targeted hydration interventions that modulate specific aspects of fluid balance without inducing systemic dehydration
Exploration of potential synergies between dehydration therapy and emerging epilepsy treatments, such as neurostimulation or gene therapies
Long-term studies to assess the efficacy and safety of intermittent or cyclic dehydration protocols in chronic epilepsy management

These research directions hold the potential to refine and expand the application of dehydration-based approaches in epilepsy treatment, potentially offering new hope for patients with difficult-to-control seizures.

Ethical Considerations in Dehydration Therapy Research

As research into dehydration therapy for epilepsy progresses, several ethical considerations come to the forefront:

Patient Safety and Informed Consent

Given the potential risks associated with dehydration, ensuring robust safety protocols and thorough informed consent processes is paramount. Researchers must carefully balance the potential benefits of the therapy against the risks of fluid restriction.

Vulnerable Populations

Special consideration must be given to vulnerable populations, such as children or individuals with cognitive impairments, who may be particularly susceptible to the effects of dehydration or may have difficulty communicating discomfort.

Long-Term Effects

The long-term implications of repeated or prolonged dehydration therapy are not fully understood. Ethical research practices must include provisions for long-term follow-up and monitoring of participants.

Equitable Access to Treatment

If dehydration therapy proves effective, ensuring equitable access to this treatment modality across different socioeconomic groups and healthcare systems becomes an important ethical consideration.

Addressing these ethical concerns is crucial for the responsible advancement of dehydration therapy research in epilepsy management.

Patient Education and Self-Management in Dehydration Therapy

Effective implementation of dehydration therapy in epilepsy management requires active patient involvement and education:

Understanding Fluid Balance

Patients must be educated about the basics of fluid balance, including signs of dehydration and overhydration. This knowledge empowers them to monitor their own hydration status effectively.

Tracking Seizure Activity

Accurate seizure diaries that include information about fluid intake can help patients and healthcare providers identify patterns and optimize treatment protocols.

Lifestyle Adaptations

Patients may need guidance on adapting their daily routines to accommodate fluid restriction, including strategies for managing thirst and maintaining comfort.

Emergency Protocols

Clear guidelines should be provided for situations where fluid restriction may need to be temporarily lifted, such as during illness or extreme heat.

Empowering patients with knowledge and self-management skills is crucial for the safe and effective implementation of dehydration therapy in epilepsy treatment.

As research into dehydration therapy for epilepsy continues, it holds promise as a potential adjunctive treatment for some patients. However, its application requires careful consideration of individual patient factors, close medical supervision, and ongoing research to fully understand its mechanisms and optimize its use. The historical foundations laid by pioneers like Dr. Temple Fay continue to inspire modern investigations, potentially leading to new breakthroughs in epilepsy management.

DEHYDRATION IN EPILEPSY | JAMA

DEHYDRATION IN EPILEPSY | JAMA | JAMA Network

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Article

April 1, 1933

J. L. FETTERMAN, M.D.^{; H. J. KUMIN, M.D.}

Author Affiliations

CLEVELAND

From the Neuropsychiatric Clinic, Lakeside Hospital, Western Reserve University School of Medicine.

JAMA. 1933;100(13):1005-1007. doi:10.1001/jama.1933.02740130009002

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Abstract

The pioneer work in the clinical application of restricted fluid intake to the treatment of epilepsy was done by Temple Fay,¹ although Hartenberg² claimed earlier use of this method as far back as 1913.

This treatment was based on the finding of increased collections of cerebrospinal fluid in epileptic patients, demonstrated by surgeons,³ by pathologists, and by roentgenologists using encephalography. Further basis for this method of treatment had been found in experimental work showing that excessive fluid predisposes animals to convulsions. Also, Gamble⁴ showed that there was a tendency to retention of body fluids just before a seizure, and McQuarrie⁵ demonstrated a parallelism between hydration and increased seizures.

Fay’s⁶ detailed observation on the therapeutic effect of dehydration in twenty-three cases of epilepsy appeared in 1931. His results showed a definite improvement in about 60 per cent of the cases.

Further favorable results from a

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12 most common seizure triggers

Our Helpline & Information Officer, Uschi Stickroth looks at 12 common seizure triggers and how you can help control them.

The unpredictability of seizures can make people with epilepsy sometimes feel powerless and out of control.

However, identifying potential triggers for seizures can be the first step towards better seizure control.

Below are 12 common seizure triggers, which will give you the knowledge and power to work on these triggers, and hopefully regaining a sense of control.

Missing medication

The most common reason for a seizure is forgetting to take your anti-epileptic drugs (AED) or deliberately not taking it.

Never skip taking your medication, no matter what the reason is, this can put you at risk of having a seizure which can be worse than normal.

Even forgetting just once can trigger a seizure.

Get into a routine to make sure you take your medication exactly as prescribed.

Alcohol

Moderate drinking (one to two units a day) is usually fine.

Many doctors, however, advise not to drink alcohol when on anti-epileptic drugs because alcohol can sometimes make these less effective.

Avoid binge drinking as this can trigger a seizure, even in those who do not have a diagnosis of epilepsy.

Recreational drugs

Many recreational drugs including legal highs can affect brain chemistry potentially triggering a seizure.

As each person reacts differently to each drug, there is no way of knowing in advance if a particular drug is ‘safe’.

Even people who do not have epilepsy can have a seizure after taking recreational drugs.

Caffeine

High concentrations of caffeine can be found in many energy or fizzy drinks, caffeine shots and pills, and even over-the-counter cold and flu remedies.

Ask your pharmacist or epilepsy specialist nurse before taking it.

As caffeine is a stimulant, it can trigger seizures in some people.

Even drinking large amounts of tea or coffee can give you more than the daily recommended amount of caffeine and this could trigger a seizure if you have already a lower seizure threshold.

Lack of sleep / tiredness

This is one of the biggest triggers for seizures. People with epilepsy generally should avoid working night shifts as this can be the cause of sleep problems which may increase seizures.

If you are affected by insomnia, ask your doctor or specialist nurse for advice.

Establish a good sleep routine; avoid caffeine in the evening.

Also, give your brain some time to switch off after watching television and switch off electronic devices an hour before you go to bed.

Stress / anxiety

Stress and anxiety can sometimes trigger a seizure in people with epilepsy.

However, there are many different ways of combatting stress.

Simple things like going for a walk, meeting up with friends or listening to music can help you step back from a stressful situation.

Breathing techniques, yoga or meditation can also be useful tools to help you cope with stress.

Boredom

For a small number of people with epilepsy, their seizures can be triggered by being bored or doing nothing.

Some people find that keeping themselves busy or using some distraction techniques when they feel a seizure coming on, can sometimes avert a seizure.

Dehydration

Keep your fluids topped up all the time. Dehydration can make it more likely for you to have a seizure.

This is particularly important when you are exercising. Also, when it is hot outside or when you are unwell with vomiting or diarrhoea.

Skipping meals

Low blood sugar can sometimes trigger a seizure in people with epilepsy.

Eating regular meals can help your seizures stay controlled. If you are thinking of going on a weight loss diet, seek advice from your doctor or specialist first.

Flashing / flickering lights

Only around 3% of people with epilepsy are photosensitive, which means their seizures tend to get triggered by flashing or flickering lights.

If you are photosensitive and suddenly find yourself faced with flashing or flickering lights, try covering one eye with one hand before you either turn away from the source or switch the TV or other device off.

This can sometimes interrupt a process in the brain avoiding a seizure.

Food triggers

Keeping a food diary alongside your seizure diary for a few weeks. This may allow you to identify anything you consume that could trigger a seizure.

Get medical advice from your doctor, specialist nurse or a dietician before you start cutting out any food groups.

This is important as this could lead to vitamin or mineral imbalances, which can sometimes make seizures worse.

Hormonal changes

Some women have more seizures at a particular point in their menstrual cycle, as monthly hormonal fluctuations can make it more likely to have a seizure.

These fluctuations also occur after childbirth and in the run up to the menopause.

If you suspect that your seizures are linked to your menstrual cycle keep a diary for a while.

Your specialist may be able to prescribe additional medication you can take around this time of the month to give you added protection against a possible increase of seizures.

For more information on seizure triggers, please check out our factsheet or email [email protected].

How to know if you are dehydrated

Learn to read your body’s signals.

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One of the rules is “If you’re thirsty, you’re already dehydrated!” One thing is for sure: thirst is far from the only signal that you need to drink water.

Dehydration occurs when your body loses more fluid than it receives. This can happen with exercise, illness that causes diarrhea or vomiting, or heat loss.

This can lead to some pretty serious problems: for example, when you’re only one percent dehydrated, it can lead to dangerous driving behavior like shifting lanes or braking late.

Bring a bottle of water with you when it’s hot, but as it gets cooler, the chance of dehydration may increase. For example, if you’re running in cold weather and wearing multiple layers, it may be harder to remember to stay hydrated.

No one can determine the exact amount of water needed for each person – it depends on diet and activity level.

However, there are several ways to tell if you are not getting enough water.

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Here are 5 signs that you may be dehydrated

Sign of dehydration: muscle cramps

When you lose fluid, nerve signals from the brain to the muscles do not go. Muscles – especially in the legs – are more likely to respond with cramps. Also, when you exercise and lose fluid, you create an imbalance of electrolytes such as sodium and potassium in your muscles.

Sign of dehydration: cravings for sweets

Your liver uses water to function. One of these tasks is to release glycogen, the molecule that stores sugar. If the liver cannot get fuel, it cannot release glucose and other energy stores.

A sign of dehydration: you feel dizzy

Part of the job of hydration is to regulate blood volume, including blood pressure. When you are dehydrated, your blood pressure drops, which can lead to dizziness.

Dehydration also affects your vestibular apparatus, which is responsible for maintaining balance.

So, in addition to the drop in blood pressure, you may also feel dizzy and even nauseous.

Sign of dehydration: no urination

If your fluid stores are severely depleted, decreased frequency of urination will be an important sign of dehydration.

This can be especially dangerous because it means your body isn’t getting rid of toxins as quickly as it should – you could even get kidney stones.

Sign of dehydration: no bowel movements

Moisturizing helps your digestive system.

How to deal with dehydration

In most cases, these symptoms are mild and can be minimized or eliminated simply by drinking more water. Listen to what your body is telling you and don’t ignore these seemingly meaningless symptoms.

If severe dehydration can be life-threatening. Therefore, if you are in a situation where you are very dizzy or have other symptoms such as extreme thirst and headache, you may need medical attention.

An endocrinologist revealed the unpleasant consequences of a banal unwillingness to drink

. What causes unwillingness to drink enough water and what is the norm

Endocrinologist Zukhra Pavlova called the cause of muscle cramps a lack of water in the body and not only dehydration of the body can become, said an endocrinologist, doctor of medical sciences, a teacher at the Faculty of Fundamental Medicine of Moscow State University named after M.V. Lomonosov Zukhra Pavlova. She called water the most important medicine, thanks to which a person feels good. You need to drink a volume per day at the rate of 30 ml per 1 kg of weight. That is, a person weighing 66 kg should consume about 2 liters of water daily.

With a deficiency of this fluid in the body, problems begin, the first sign of which is dry mouth. The doctor listed other troubles arising from dehydration.

Edema

According to Pavlova, it is edema that becomes the first thing that the body “presents” to a person for dehydration.

“This is how he stores those small milliliters that you give him. If there is enough water, then swelling even in summer does not threaten you. It is important to understand that we are talking about those edema that happen from time to time. If they torment you constantly, it means that the cardiovascular, urinary or endocrine systems are not in order.

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Nocturnal and daytime calf cramps

Water is essential for good conduction of nerve impulses in the muscles. If it is not enough, then the impulses go astray and cause involuntary convulsions.

Unpleasant dry eyes

With normal water intake, Zukhra Pavlova explained, the mucous membranes are always well hydrated. But if there is not enough water, then there is a feeling of dryness not only in the eyes, but also in the nose and throat.

Heaviness in the head

With a lack of water in the body, the head may begin to ache. The endocrinologist advised me to try to drink a glass of water if such a sensation occurs, and this often solves the problem of an aching head.

Creaking in the joints

As the doctor explained, the joint capsule is filled with a special fluid. If there is little water in the body, then the bag “dries out” and the joints begin to rub against each other and creak.

Remarkably: intervertebral discs are also almost 80% water, the doctor noted.

False hunger