Tag Archives: caffeine

Epilepsy

The deleterious effect of caffeine on epilepsy and anti-epileptic agents

Virginia Thornley, M.D., Neurologist, Epileptologist
March 25, 2019
Introduction
Caffeine (1,3,7-methylxantine) is one of the most commonly ingested stimulants in the world. It is not uncommon for someone to ingest a daily consumption of 200mg of caffeine a day. It is ubiquitously found in soda, coffee, tea, and chocolate. It is the bane of every neurologist who treats migraine and patients with insomnia. It acts as a stimulant and many people use it to counter fatigue induced by lack of sleep. Students consume it to stay up at night for late night studying in order to ace their tests the next day. Millions of people ingest caffeine on a regular basis to get through the full work day.
Caffeine worsen seizures
It has been found in animal models to lower the seizure threshold. At low doses, it reduces the efficacy of anti-epileptic agents. At more than 400mg of caffeine per day, in rodent models it is found to induce seizures. In experimental data, use of caffeine is found to lower the seizure threshold. In mouse models, at lower doses below the seizure-inducing effects, it is found to counter the protective beneficial effects of anti-epileptic agents such as carbamazepine, phenytoin, valproate, and phenobarbital as well as newer agents such as topiramate.  There seems to be no effect of caffeine on newer agents such as tiagabine, oxcarbazepine or lamotrigine. There is clinical data confirming that ingesting high doses of caffeine correlates with greater number of seizures.
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Dark cocoa and seizures
Dark chocolate is also found to be a proconvulsant, but little is known about the mechanism of action. Dark chocolate is rich in caffeine. In one mouse study, the effect of high intake of dark chocolate on the susceptibility of hippocampal cells to seizures was examined. Dark cocoa appeared not to affect mood behavior but improved motor coordination.  However, electrophysiologic studies showed enhancement of bursts of epileptogenic potential within the dentate gyrus of the hippocampus. There was a reduction in GABA-alpha receptors suggesting that consumption of dark chocolate may alter the synaptic aspect of epileptogenesis in the temporal lobe.
These findings suggest that high consumption of caffeine especially dark cocoa can increase seizure frequency in animal models and in clinical studies. It seems to act as a proconvulsant and reduces receptors that are necessary for inhibiting seizures.
Reference
  1. Chroscinska-Krawzyk, et al, “Caffeine and anticonvulsant potency of anti-epileptic drugs: experimental and clinical data,” Pharmacol. Rep., 2011, 63(1):12-18.
  2. Cicvaric, et al, “Sustained consumption of cocoa-based dark chocolate enhances seizure-like events in the mouse hippocampus,” Food Funct., 2018, Mar., 1, 9(3):1532-1544.
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migraine

Migraine:Non-Pharmacologic Ways to Deal with Migraines

By Virginia Thornley, M.D., Neurologist
February 15, 2018

Introduction
Migraines are characterized by recurrent pounding, throbbing pain, occurring on one side of the head. At times, it alternates.  At its highest intensity, it is rated a 10/10 on the pain scale. It is often accompanied by nausea, vomiting, sensitivity to bright lights and loud noises. It may or may not be accompanied by visual symptoms which can range from seeing bright lights to seeing sophisticated patterns of color called fortifications that often migrate across your visual fields. The frequency may vary from infrequent to a daily basis. Some patients may have other neurological symptoms that accompany it, however, migraine is a diagnosis of exclusion. In other words, other more serious causes are ruled out before a diagnosis of migraine can be concluded if you also experience other neurological symptoms. It is important to be fully evaluated by a neurologist to exclude other possible neurological etiologies.

Lifestyle changes that help reduce migraine frequency
There are non-pharmacologic measures which may reduce the frequency of migraines. Oftentimes, triggers can be found. Lifestyle changes are the hardest to do but they greatly minimize the frequency of migraines.

Avoidance of caffeine
If large amounts of coffee are consumed, tapering can help ease into complete cessation. A sudden cessation may result in withdrawal effects of caffeine which can involve headaches. Common sources of caffeine include coffee, tea, soda, and chocolate. Avoidance of beverages labeled as decaffeinated as there is still a small amount of caffeine is also beneficial.

There is a lot of myth and misinformation. Many migraineurs say that caffeine alleviates their headaches. Caffeine can help a migraine in the short-term, however, it prolongs a migraine cycle. Refer to a neurologist for questions.

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Obtain adequate sleep
Adequate rest at night is important. This may vary from 6-8 hours. A rule of thumb is if one cannot drag themselves out of bed sleep is inadequate.  Adequate sleep means waking up refreshed. Sleep requirements vary per individual. Sleep deprivation propagates the migraine cycle. Sleep must be continuous and nocturnal allowing the body to enter the restorative deep wave sleep at stages 3 and 4 of sleep. Even if prolonged sleep occurs if constantly interrupted one will not wake up refreshed since the natural sleep cycle is disrupted and only light sleep stages 1 and 2 will occur. It should be nocturnal, the body is designed to sleep at night when hormones are secreted, daytime sleep will not have the same quality.

Avoidance of food triggers
A food journal provides much useful information. Common culprits include wine, cheese, hot dogs, and fish. Certain red meat may trigger migraine. Food triggers vary per patient and are unique to each individual.

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Avoidance of excessive use of over the counter medications
Over the counter medications are easily accessible and consumable. A common pitfall is to overuse these medications. When stopped abruptly, rebound headache may result. It is not infrequent for patients with migraine headaches to have rebound headaches compounding the condition.

Magnesium use
Magnesium is known to help with migraine. Intravenous magnesium is often used in the hospital setting in status migrainosus which is a continuous extremely painful migraine which sometimes lasts up to weeks. Magnesium is a mineral found naturally in food. Oral magnesium oxide at specific doses is helpful in preventing the migraine cycle.

Riboflavin use
Riboflavin is found naturally in the diet. It can prevent the migraine cycle at specific doses.

Other lifestyle changes
Other lifestyle changes include keeping hydrated especially during hot weather, eating 3 meals a day and avoiding hunger. Some triggers are unique to individuals. Avoiding stress helps with migraines. A zen-like environment is optimal.

Medications are often prescribed for the management of frequent migraine headaches. They are divided into 2 classes, preventative and abortive agents. However, even the best medications will not work effectively if triggers or aggravating factors are still present as mentioned above in daily life.

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Epilepsy, migraine

Sleep Hygiene especially for Migraineurs and those with Epilepsy

By Virginia Thornley, M.D., Neurologist, Epileptologist
February 15, 2018

Introduction
Many neurological diseases are affected by lack of sleep most significantly migraine and epilepsy. A person performs suboptimally with lack of sleep with inattention and lack of coordination. In someone with a neurological condition, the symptoms become even more manifest. Weakness becomes more prominent, double vision may be more pronounced and difficulty speaking will become more prominent. Sleep plays a vital role in the restorative function of the body.

Stages of sleep, why adequate and continuous sleep is refreshing
Sleep is divided into 2 categories, Non-REM (rapid eye movement) sleep and REM sleep. During non-REM sleep, there are 4 stages. Stage 1 and 2 constitute drowsiness which transitions into light sleep. The electroencephalogram is a study that reflects brain activity. Stages 1 and 2 demonstrates sleep complexes including vertex waves then K complexes. Sleep spindles occur during stage 2 sleep. During stages 3 and 4 also known as slow-wave sleep, delta waves which are the slowest waves between 1-3 Hertz start to occur. Stage 4 shows delta waves of greater than 50% of the recording. People enter these stages of sleep and then subsequent REM sleep. REM sleep is where dreaming occurs.

One can go through a few cycles of these so that you wake up refreshed. Continue reading →

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