Excess Caffeine May Make Seizure Control Tougher

When a person with epilepsy adequately controlled by medication suddenly begins having more frequent seizures, excess caffeine intake could be the culprit, a report suggests.

``This case presents the point that people with epilepsy should minimally use caffeine,'' says Dr. Kenneth R. Kaufman, associate professor of psychiatry at the Robert Wood Johnson Medical School in New Brunswick, New Jersey. ``One needs to avoid tea, coffee, chocolates, cocoa and many of the caffeinated sodas.''

Kaufman and his colleague Dr. Rajesh Sachdeo, clinical professor of neurology and director of the hospital's epilepsy program, presented a case study addressing the effect of caffeine on seizure frequency.

The researchers described the 49-year-old man who had been having seizures for 36 years. His convulsions had been successfully controlled with the drugs phenytoin and primidone.

The man began experiencing a sharp rise in the frequency of his seizures, even though he was continuing to take his medication and his sleep patterns and stress levels had not changed. Lack of sleep and increased stress are both known to make seizure control more difficult.

Several newer anticonvulsive drugs, which may have fewer side effects than older medications, have been introduced recently, Kaufman and Sachdeo noted. They considered switching the man to one of these medications until they reviewed his diet and discovered he had recently begun consuming 2 quarts a day of a popular caffeinated, bottled iced tea drink. After he switched to a decaffeinated drink, his seizures subsided.

The researchers explained that chemical substances known as methylxanthines, which include caffeine, have been reported to promote convulsions in animals. When a patient begins suffering more seizures, doctors should investigate the patient's diet for any recent changes before switching his or her medication, Kaufman and Sachdeo suggest.

``Beyond the medications, one has to ask the question, 'What types of seizure threshold-lowering behaviors might be occurring?''' Kaufman added. ``Caffeine (intake) may be a seizure threshold-lowering behavior.''