For many people with epilepsy, it is possible to identify factors that may provoke seizures. In one study, patients reported that forgetting to take medication (84%), emotional state (58%), sleep loss (56%), menses (54%), physiologic state (32%), specific sensory stimuli (21%), alcohol consumption (20%), and illness (11%) were the most common factors that exacerbated their epilepsy.24 For some persons, relaxation therapy or avoidance of stressors can help reduce seizure frequency, but these measures are rarely able to control seizures fully in someone whose epilepsy is intractable to medications. For patients who believe that alcohol use or withdrawal exacerbates their seizures, intake should be stopped or carefully restricted. Catame-nial seizures remain a challenge because no treatment strategy is clearly effective in reducing them except hormonal therapy that renders the woman anovulatory.25
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