Patient Workbook · Seizure Management

The Seizure Threshold Audit
Your Environment · Your Inputs · Your Action Plan

"You can't consent to what you've never been told."

Every item in this audit is a documented mechanism — not a theory. This is not about doing everything at once. It is about knowing what is in your environment so you can make informed decisions about what to address first. That is what informed consent looks like.

This workbook applies to both adults with seizure disorders and parents managing a child's seizures. Throughout, "I" refers to yourself or the person in your care.

Start Here

What is a seizure?

Your brain communicates through electrical signals. Neurons — brain cells — fire in precise, coordinated patterns to produce every thought, movement, sensation, and reflex. A seizure happens when that coordination breaks down and a region of the brain fires all at once, all out of sequence, like a power surge through a circuit that wasn't designed to carry that load.

Where the surge happens determines what you experience. If it stays in one region — the temporal lobe, which processes emotion and memory — you might feel a wave of fear or déjà vu, or smell something that isn't there. If it spreads across both hemispheres of the brain, you lose consciousness and your body convulses. If it happens in the brain's electrical relay system — the thalamus — you go blank for a few seconds, then return, with no memory of leaving. These are all seizures. They look completely different because different parts of the brain do completely different things.

Every brain has a seizure threshold — a level of electrical stability below which a seizure becomes possible. That threshold is not fixed. It moves. Mineral deficiencies, sleep deprivation, chemical exposures, medication interactions, infections, and accumulated stress all lower it. The threshold concept is the one thing most patients are never told at diagnosis — because if they were, the conversation would have to include everything in this workbook.

What you were not told

Each seizure is a head injury.

Not in the sense of blunt trauma. In the sense of what happens to brain tissue during and after a seizure event — and why it matters that you know this before deciding how you want to manage what's happening to your brain.

During a seizure, affected neurons fire continuously and at high intensity. This consumes enormous amounts of energy — glucose and oxygen — faster than blood flow can replenish it. The result is localized hypoxia: a period of reduced oxygen in the brain tissue involved. At the same time, the surge of electrical activity triggers the release of glutamate — the brain's primary excitatory (activating) neurotransmitter — at levels high enough to be toxic to the neurons receiving it. This process is called excitotoxicity. Neurons that survive one event may sustain cumulative damage across multiple events.

The post-ictal period — the hours of exhaustion, confusion, and sometimes pain that follow a seizure — is your brain's recovery from that event. It is not simply tiredness. It is a system coming back online after a traumatic electrical overload.

Longitudinal research shows measurable hippocampal atrophy — shrinkage of the hippocampus, the brain region central to memory and spatial navigation — in people with uncontrolled seizures over time. And critically: each seizure can lower the threshold for the next one. The brain adapts to the pattern of seizing. This is called kindling. It is the reason that managing the threshold — reducing every controllable input that lowers it — is not a fringe approach. It is the most rational approach.

The appointment you probably had

The questions you were probably not asked.

At the appointment after your first seizure — or your child's — a diagnosis was made and a medication was prescribed. What was probably not asked:

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What is your water source — specifically, does it contain fluoride?

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What is your magnesium level? Magnesium directly regulates the NMDA receptor — the main voltage gate on neurons. Low magnesium lowers the seizure threshold measurably.

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What medications — including over-the-counter — were you taking in the weeks before onset? Many common drugs lower the seizure threshold.

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Did you have an illness — viral or bacterial — in the weeks before the first event? Neurological inflammation is a documented trigger.

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What are your pesticide exposures — at home, at school, in food? Organophosphates are documented neurotoxins that disrupt acetylcholinesterase, the enzyme that stops nerve signals from firing continuously.

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What is your sleep pattern? Severe sleep deprivation alone can trigger a seizure in anyone — it is used as a provocation test in EEG studies.

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Have you had any recent vaccine reactions — fever, neurological symptoms, or prolonged illness following a vaccination?

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What artificial additives — aspartame, MSG, food dyes — are in your daily diet? Several are documented to lower the seizure threshold.

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What is your electromagnetic exposure at home and at work — specifically near high-voltage equipment or wireless infrastructure?

None of these questions would have changed your diagnosis in a single appointment. But any one of them could have changed your trajectory. The workbook below is the investigation that appointment did not start.

My Trigger Audit

Check every item that applies to your current daily life. Be honest — this is for you. The more boxes you check, the clearer your picture becomes.

Water

I drink fluoridated municipal tap water

I drink filtered water but don't know if the filter removes fluoride

I drink distilled or reverse osmosis water (mineral-stripped — pulls minerals from tissue to re-equilibrate)

My "filtered" water uses a zero-TDS or ZeroWater-style filter (strips minerals the same as RO)

My bottled spring water is ozonated (ozonation depletes mineral profile and generates disinfection byproducts)

I drink from aluminum cans regularly (soda, sparkling water, energy drinks)

I rarely drink plain water throughout the day

I use Gatorade, Powerade, Liquid IV, or other processed electrolyte drinks — formulated for acute athletic sweat, not neurological mineral balance; contain artificial dyes and sugars that compound glucose instability

I drink very large volumes of plain water daily — dilutional hyponatremia (low sodium from excess water) is a documented seizure trigger; the goal is mineral-rich hydration, not maximum volume

Goal: natural spring water (findaspring.com) or non-ozonated bottled spring water · glass or stainless steel containers

Food & Diet

I eat processed food daily (packaged, fast food, restaurant more than 3x/week)

I use artificial sweeteners — aspartame (diet drinks, Equal), sucralose (Splenda), acesulfame-K

I eat foods with MSG, hydrolyzed protein, yeast extract, or "natural flavors" regularly

I eat conventional (non-organic) produce from the Dirty Dozen list

My child eats candy regularly — gummies, sour candy, hard candy, chocolate

I eat conventional meat, dairy, or farmed fish (not pasture-raised or wild-caught)

I skip meals or go more than 4–5 hours without eating regularly

I eat carbohydrate-only meals without protein or fat

I eat artificial food dyes daily (brightly colored snacks, cereals, drinks) — Red 40, Yellow 5/6, Blue 1/2 contain benzidine, a neurotoxin and carcinogen, as a manufacturing contaminant

My child eats tamarind candy, chili-salt candy, or Mexican import candy — tested positive for lead contamination by California health authorities

I eat fortified breakfast cereals daily — synthetic iron (ferrous sulfate) competes with zinc and copper absorption; generates oxidative stress in gut

My diet is heavily grain-based (conventional wheat, oats, corn, soy) — high glyphosate residue; glyphosate chelates magnesium and zinc and disrupts GABA-producing gut bacteria

Caffeine & Stimulants

I drink coffee, tea, or caffeinated beverages daily

I use energy drinks (Monster, Red Bull, Celsius, Reign, etc.)

I use pre-workout supplements

I use protein powders (whey, plant-based, collagen with additives)

I take OTC medications containing caffeine (Excedrin, Midol, Anacin, NoDoz)

I chew caffeine gum or use caffeine mints — buccal absorption is faster and steeper than coffee; adenosine blockade spike is immediate

I drink caffeinated sparkling water (Celsius, Bubly Bounce, Sparkling Ice+Caffeine) — marketed as water, 35–200mg caffeine per can

Ivape or use e-cigarettes — aerosolized aldehydes (formaldehyde, acetaldehyde) are direct NMDA activators; heavy metals from coil inhaled with every puff

I use Zyn or nicotine pouches — high-dose buccal nicotine spike; undisclosed binders and flavors absorbed through oral mucosa

I smoke cigarettes — carbon monoxide reduces blood oxygen by up to 15–20%; cerebral hypoxia degrades inhibitory tone; cadmium and lead from tobacco inhaled daily

I chew conventional gum daily — aspartame → aspartate (NMDA agonist) absorbed buccally; artificial dyes and flavors with sustained mucosal contact

Supplements & Personal Care

I take a daily multivitamin — check for preformed retinol (retinyl palmitate/acetate), synthetic folic acid, inorganic iron, high-dose zinc without copper

I supplement with Vitamin D (D3 capsules or drops) — raises serum calcium, activating voltage-gated calcium channels (same pathway as EMF); sunlight does not carry this risk

I take high-dose zinc (immune support, lozenges, or zinc-only supplement) without copper — suppresses copper absorption; copper is required for cytochrome c oxidase and dopamine metabolism

I use fluoride toothpaste (standard OTC brands: 1,000–1,450 ppm)

I have been prescribed high-strength fluoride toothpaste (PreviDent, DentalPro 5000 — 5,000 ppm, 3–5× standard) for home daily use — significantly higher daily mucosal fluoride exposure than in-office varnish

I use NHA (nano-hydroxyapatite) toothpaste marketed as fluoride-free

My child swallows toothpaste (under 8 years old) — mucosal absorption bypasses liver; fluoride + any lead contamination goes directly to blood

My shampoo, body wash, or deodorant contains "fragrance" or "parfum" — phthalate carriers are anti-androgenic xenoestrogens absorbed through skin; parabens add estrogenic burden

I take OTC antihistamines, pain relievers, or cold medicine regularly

I have taken a fluoroquinolone antibiotic (Cipro, Levaquin, Avelox) in the past 2 years — GABA-A antagonist; lowers seizure threshold; in FDA black box warning

Cookware & Food Packaging

I cook with nonstick (Teflon/PTFE) pans — especially on high heat

My nonstick pans have scratches or chips in the coating

I drink from aluminum cans regularly

I store or heat food in plastic containers

I use plastic water bottles daily

I drink hot coffee, tea, or hot chocolate from a single-use plastic cup, polystyrene cup, or plastic-lined paper cup — heat accelerates BPA/BPS leaching dramatically; xenoestrogen load is highest with hot liquids

I use a Keurig or pod-style coffee maker — boiling water passes through plastic housing before reaching the cup

My travel mug has a plastic interior lining — check for "BPA-free" label; BPS and BPF replacements carry equivalent estrogenic activity

Bedroom & Home Environment

My Wi-Fi router is on overnight (not on a timer)

I charge my phone on or near my nightstand

I have a smart TV, streaming stick, or other device in my bedroom

My smart meter is on a bedroom wall or within 15 feet of where I sleep

I can see a cell tower, power lines, or electrical infrastructure from my home

I have solar panels on or near the house (inverter creates dirty electricity)

I use LED lighting in my bedroom or main living areas in the evening

My bedroom is not fully dark at night

I use Bluetooth headphones or earbuds regularly (including while sleeping)

I have plug-in air fresheners in the bedroom or main living areas — continuously aerosolize aldehydes (formaldehyde, acetaldehyde — an NMDA activator) into room air

I use scented laundry detergent, dryer sheets, or fragrance booster pellets (Unstopables, Downy Beads) — engineered to remain on fabric and continue releasing fragrance chemicals into the breathing zone throughout sleep

My mattress is a newer foam mattress with no offgassing period — polyurethane foam + flame retardants (PBDEs) offgas VOCs into the bedroom, highest in enclosed rooms overnight

I burn candles, incense, or use reed diffusers indoors — combustion and fragrance oxidation generate benzene, acetaldehyde, and other airborne neurotoxins

Screens & Gaming

Iuse screens within 1 hour of bedtime

Igame in a dark room with the screen as the main light source

Gaming setup includes wireless headphones, wireless controller, and phone nearby simultaneously

Iuse a gaming chair with built-in speakers or wireless mic

I drive past tree-lined roads or through sunlight flickering through trees at speed

Iuse a VR headset — screens 2–3cm from eyes with Bluetooth/Wi-Fi hardware against the skull; documented seizure trigger in photosensitive epilepsy (Sony/MHRA labeling)

Gaming setup is a high-performance PC (500–1,500W) — EMF from switching power supply and GPU is significantly higher than standard household electronics

Sunlight & Sleep

I do not get outdoor morning sunlight within the first hour after waking

My first light exposure is a screen (phone, computer, TV)

I sleep fewer than 7–8 hours most nights

I wake with a dry mouth or have been told I snore or stop breathing

I sleep on my back (not my side)

My sleep is irregular — different bedtimes each night

History & Hormones

I have a history of head injury, sports concussion, or whiplash

I was born with forceps, vacuum, or in a prolonged/difficult delivery

My seizures cluster around my menstrual period, ovulation, or premenstrual phase (women)

I have not had a full thyroid panel (free T3, free T4, TSH, TPO antibodies)

I have not had a morning cortisol test

I received fluoride varnish at my last dental cleaning

My dental work used epinephrine-containing local anesthetic

My waking temperature — taken before sitting up, same time each morning — consistently runs below 97.8°F (36.6°C). This suggests thyroid suppression: not enough T3 reaching the cells, even if TSH looks “normal.”

My temperature drops sharply in the days before my period — matching when my seizures tend to cluster. (Progesterone withdrawal lowers both temperature and seizure threshold.)

How to track basal body temperature (BBT)

Take your temperature before you sit up or speak — the moment you wake. Use an oral or underarm thermometer. Record it at roughly the same time each morning (± 30 minutes). After 2–3 weeks a pattern emerges.

  • Consistently below 97.8°F (36.6°C): flag for thyroid — low T3 slows GABA synthesis, slows nerve recovery between firings, and raises seizure susceptibility
  • Temperature rise of 0.2–0.5°F mid-cycle: marks ovulation and progesterone rise — protective window for many women with catamenial (menstrual-linked) seizures
  • Sudden drop before menstruation: progesterone withdrawal — highest-risk window for catamenial seizures; log it in the daily tracking column

Record your daily BBT in the “BBT °F” column of the 30-day log.

Medications Taken

List your current medications — AEDs and anything else taken regularly. Check any that apply.

Current AED(s)

Other medications

Flag items — check any that apply:

I take a proton pump inhibitor (Prilosec, Nexium, Prevacid, omeprazole) — depletes magnesium, the brain's natural NMDA channel blocker

I take a benzodiazepine (Xanax, Valium, Ativan, Klonopin) — tolerance and withdrawal between doses can lower seizure threshold

I take oral contraceptives — deplete B6 and folate; B6 is required to produce GABA

I take corticosteroids (prednisone, methylprednisolone) — blood sugar dysregulation affects neuronal stability

I take metformin — depletes B12; B12 deficiency causes neurological effects including increased excitability

I take a daily antihistamine (Benadryl, Zyrtec, Allegra) — Benadryl (diphenhydramine) lowers seizure threshold; anticholinergic burden compounds in combination with other medications

I take bupropion (Wellbutrin, Zyban) — among the highest seizure risk of all antidepressants; dose-dependent; was temporarily withdrawn from market after seizure deaths

I take tramadol (Ultram) — directly lowers seizure threshold; risk multiplies with SSRIs; commonly prescribed for pain in adolescents and young adults without seizure-history check

I take an antipsychotic (quetiapine/Seroquel, olanzapine/Zyprexa, risperidone/Risperdal, haloperidol/Haldol, clozapine/Clozaril) — all lower seizure threshold dose-dependently

I take a tricyclic antidepressant (amitriptyline/Elavil, nortriptyline, clomipramine/Anafranil) — well-documented seizure threshold lowering; frequently prescribed for pain, migraine, or sleep

I have been prescribed any new medication in the past 3 months without the prescribing doctor being told about my seizure disorder — every new prescription warrants the question: does this lower seizure threshold?

I am currently taking or recently completed a course of antibiotics — see Antibiotics section below

I have started, stopped, or changed AED doses in the past 3 months

Antibiotics — History & Class

Not all antibiotics carry the same neurological risk. Check any class you have taken — recently or repeatedly in the past. Use this list to start a conversation with your prescriber.

Fluoroquinolone — Cipro, Levaquin, Avelox, Floxin, Factive, Noroxin, Baxdela

Published side effects: seizures (FDA Black Box Warning), confusion, hallucinations, dizziness, insomnia, tendon rupture, and peripheral neuropathy (which may be permanent). Also disrupts gut bacteria that produce GABA and neurotransmitter precursors. Discuss with your provider: Is there a lower-risk alternative for this infection given my seizure history?

Metronidazole / Tinidazole — Flagyl · Tindamax (same class, same risks)

Published side effects: seizures (listed in prescribing information), confusion, dizziness, headache, coordination problems, slurred speech, peripheral neuropathy, nausea, and metallic taste. Discuss with your provider: Is there an alternative for this infection that does not carry the same CNS risk?

Cephalosporin — 1st gen: Keflex (cephalexin), Duricef (cefadroxil), Ancef (IV) · 2nd gen: Ceftin, Cefzil, Ceclor · 3rd gen: Omnicef, Suprax, Vantin, Rocephin (injection) · 4th gen: Maxipime (IV)

Published side effects: seizures (listed in prescribing information — not a rare theoretical risk), myoclonus (muscle jerking), encephalopathy, confusion, and dizziness. Risk increases if kidney function is impaired, as cephalexin is primarily cleared by the kidneys — the drug accumulates when clearance is reduced. Discuss with your provider: Has my kidney function been checked recently? Is there an alternative for this infection?

TMP-SMX — Bactrim, Septra

Published side effects: anemia, rash, nausea, and kidney effects. Known to raise blood levels of certain AEDs including valproate (Depakote) and lamotrigine (Lamictal) — which can cause AED toxicity symptoms even without a dose change. Discuss with your provider: Do I need AED level monitoring during and after this course?

Amoxicillin (Amoxil), doxycycline (Vibramycin, Doryx), azithromycin (Zithromax / Z-pack), clindamycin (Cleocin), nitrofurantoin (Macrobid, Macrodantin)

Lower neurological risk compared to the classes above. All antibiotics disrupt gut bacteria that produce GABA and neurotransmitter precursors. Discuss with your provider: What probiotic support is appropriate during and after this course?

I have taken 3 or more antibiotic courses in the past 12 months

I have never taken a probiotic after an antibiotic course

Full antibiotic comparison by neurological risk class: seizures.html → Informed Consent tab → "Not all antibiotics carry the same neurological risk"

Dental Procedures & Anesthetics

A routine dental appointment involves several agents that directly affect seizure threshold. Check any that apply to recent or upcoming appointments.

I received topical fluoride varnish (22,600 ppm — in-office, a few times/year) at my last dental cleaning

My dentist prescribed high-strength fluoride toothpaste (PreviDent 5000 ppm) for home daily use — 3–5× standard toothpaste, used twice daily; higher cumulative daily mucosal exposure than in-office varnish; no safe threshold established for neurological conditions

My local anesthetic contained epinephrine (adrenaline) — published side effects include rapid heartbeat, elevated blood pressure, anxiety, and headache; can lower seizure threshold

My anesthetic was articaine — now the most commonly used dental local anesthetic in the US; crosses the blood-brain barrier more readily than lidocaine due to higher lipid solubility; at toxic plasma levels all local anesthetics cause seizures, and articaine reaches CNS threshold more easily

I received nitrous oxide sedation — published side effects include nausea, headache, and with repeated use: B12 depletion leading to nerve damage and neurological decline

I have amalgam (silver) fillings that have not been safely removed

I have composite (white/tooth-colored) fillings — most contain Bis-DMA (bisphenol A dimethacrylate), which converts to BPA (a xenoestrogen that mimics estrogen) in saliva; estrogen is pro-convulsant

My child has had dental sealants applied — resin-based sealants use the same Bis-DMA/BPA chemistry; release is highest in the first 24 hours after placement; glass ionomer-based alternatives exist

My fillings or sealants are glass ionomer — no BPA, but glass ionomer continuously releases fluoride; relevant if fluoride burden is already a concern

I have had amalgam removed without rubber dam, oxygen, or SMART protocol

I have dental work planned and have not discussed my seizure disorder with my dentist

My dentist does not know I prefer epinephrine-free anesthetic — and prefer to avoid articaine; alternatives: mepivacaine 3% plain, prilocaine 4% plain, or lidocaine without epinephrine

I have had dental X-rays this year without discussing frequency with my dentist — any patient may decline; "digital" still uses ionizing radiation; Claus et al. 2012 found 2.9× elevated meningioma risk with panoramic X-rays; effect strongest in children; ADA supports 18–24 month intervals for low-risk adults; seizure diagnosis should be on the dental chart

My dentist has recommended CBCT (cone beam CT) imaging — CBCT delivers 10–60× more radiation than a standard bitewing; ask whether a standard X-ray would answer the same clinical question before agreeing

I feel anxious before dental appointments — anticipatory stress raises cortisol before the first instrument is used; cortisol reduces hippocampal GABA expression and lowers seizure threshold; inform the dentist of the diagnosis so the team knows what to watch for

I have had or will have contrast-enhanced CT or MRI for seizure workup — both iodinated contrast (CT) and gadolinium (MRI) can lower seizure threshold; documented in case literature and manufacturer labels; gadolinium deposits in brain tissue with repeated use (FDA DSC 2017); ask whether non-contrast imaging would answer the clinical question before consenting to contrast

Before your next dental appointment

Print the dental information sheet and bring it to your appointment. It documents your preferences, lists the agents to avoid with the mechanism for each, and includes an emergency protocol. Download: Dental Care & Seizure Disorders — Patient Information Sheet

My audit summary — what stands out most:

The Medications

Anti-seizure medications are real tools that help real people. For many, they are essential. Informed consent means knowing what your medication does, what the FDA has required be disclosed, and what it depletes from the body — because several of these drugs deplete the very nutrients that regulate seizure threshold. That information belongs in the prescribing conversation. It almost never is.

FDA class warning — applies to every antiepileptic drug on this page: All antiepileptic drugs carry a black box warning for increased risk of suicidal thoughts and behavior. Any patient or caregiver who notices new or worsening depression, hopelessness, or thoughts of self-harm should contact their prescriber immediately.

Valproic Acid / Valproate

Depakote, Depakene, Depacon · Anticonvulsant / Mood Stabilizer

3 Black Box Warnings

Valproate works by increasing GABA — the brain's main calming neurotransmitter — and by blocking sodium channels that trigger neuron firing. It is one of the most widely prescribed antiepileptic drugs and also one of the most dangerous, with three separate FDA black box warnings.

■ Black Box Warnings

Liver failure — fatal cases documented; highest risk in children under 2 on multiple seizure drugs simultaneously; requires regular liver monitoring.

Pancreatitis — inflammation of the pancreas (the organ behind the stomach that makes digestive enzymes and regulates blood sugar); can be life-threatening; abdominal pain requires immediate evaluation.

Birth defects — valproate is among the most teratogenic (birth-defect-causing) drugs in clinical use; causes spina bifida (a spinal cord defect) in 1–2% of pregnancies; linked to autism and cognitive impairment in exposed children; the European Medicines Agency restricted its use in women of childbearing age in 2018.

What it depletes — and why that matters for your threshold

  • L-carnitine — valproate is the leading drug cause of carnitine depletion; carnitine transports fatty acids into mitochondria (the cell's energy producers); low carnitine causes fatigue, muscle weakness, and in severe cases metabolic crisis in children
  • Zinc — zinc regulates GABA-A receptors (the receptors valproate is trying to support); depleting zinc undermines the drug's own mechanism
  • Folate — essential for DNA repair, neurotransmitter synthesis, and fetal development; depletion amplifies the already serious birth defect risk
  • Selenium — antioxidant mineral that protects brain and liver tissue; depletion adds to liver stress in a drug already associated with liver failure

Levetiracetam

Keppra · Anticonvulsant

Psychiatric Effects

Levetiracetam is now one of the most frequently prescribed seizure medications. Its mechanism is different from older drugs — it binds to a synaptic vesicle protein (SV2A) that affects how neurons release neurotransmitters. It is often presented as better tolerated than older AEDs. The side effect patients and caregivers actually report most is known informally as "Keppra rage."

■ What patients and caregivers actually experience

"Keppra rage" — sudden, intense aggression, irritability, hostility, and behavioral outbursts that can emerge without warning in patients with no prior history of these behaviors; documented in adults and children; often minimized at the prescribing appointment.

Depression and suicidal ideation — carries the class BBW for suicidality; psychiatric monitoring is required.

What it depletes — and why that matters

  • Vitamin B6 (pyridoxine) — this is critical: B6 is the cofactor required to synthesize GABA — the brain's primary inhibitory (calming) neurotransmitter. Levetiracetam depletes B6. Low B6 means less GABA production. Lower GABA means a lower seizure threshold. The medication depletes a nutrient that its own mechanism depends on. Clinical studies show that correcting B6 deficiency can reduce the behavioral side effects of levetiracetam.

Lamotrigine

Lamictal · Anticonvulsant / Mood Stabilizer

Stevens-Johnson Syndrome Risk

Lamotrigine blocks sodium channels to stabilize neuron firing. It must be started at a very low dose and increased extremely slowly — sometimes over months — because the risk of the most dangerous side effect is directly tied to how fast the dose is raised.

■ Black Box Warning

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) — both are potentially fatal skin reactions in which the skin begins to blister and peel away from the body as if severely burned. Risk is highest in the first 8 weeks of treatment and in children. Any rash while taking lamotrigine must be taken seriously and reported to the prescriber immediately. The FDA warning exists because this reaction has been fatal.

What it depletes

  • Folate — essential for DNA repair and neurotransmitter synthesis; depletion raises homocysteine (a marker of cardiovascular risk and neurological stress)
  • Biotin (B7) — required for fatty acid synthesis and gene regulation; deficiency causes hair thinning, fatigue, and skin changes

Carbamazepine

Tegretol, Carbatrol · Anticonvulsant / Mood Stabilizer

Aplastic Anemia / SJS Risk

One of the older antiepileptic drugs, carbamazepine blocks sodium channels and reduces the spread of electrical activity. It has a narrow therapeutic window — meaning the difference between a dose that works and a dose that becomes toxic is small. It also has one of the most aggressive nutrient depletion profiles of any anticonvulsant.

■ Serious risks

Aplastic anemia — the bone marrow stops producing blood cells; rare but can be fatal; requires blood monitoring.

Stevens-Johnson Syndrome — same life-threatening skin reaction as lamotrigine; risk is higher in people of Han Chinese, Thai, or Malaysian descent due to a genetic variant (HLA-B*1502).

Hyponatremia — low sodium (salt) levels in the blood; sodium is essential for nerve signal transmission; the drug that is supposed to stabilize nerve signals can cause the electrolyte imbalance that destabilizes them.

What it depletes

  • Folate — actively depleted; elevated homocysteine risk; critical for women of childbearing age
  • Vitamin B12 — neurological protection; depletion causes peripheral neuropathy (numbness and tingling in hands and feet) and cognitive effects that compound the drug's own side effects
  • Biotin (B7) — carbamazepine impairs biotinidase, the enzyme that recycles biotin; hair thinning, fatigue, skin changes
  • Vitamin D — carbamazepine is a potent inducer of CYP3A4, the liver enzyme that breaks down vitamin D; long-term users develop vitamin D deficiency, calcium loss, and fragile bones — a condition called anticonvulsant osteomalacia (soft, weakened bones from mineral depletion)
  • Sodium — directly depleted through the drug's effect on kidney sodium reabsorption

Phenytoin

Dilantin · Anticonvulsant — one of the oldest

Narrow Therapeutic Window

Phenytoin has been in use since 1938. It blocks sodium channels like carbamazepine, but its therapeutic window — the range between a dose that works and a dose that becomes toxic — is extremely narrow and varies significantly between individuals. It has one of the worst nutrient depletion profiles of any drug in clinical use.

■ Serious risks

Phenytoin toxicity — at levels just above therapeutic, patients develop nystagmus (uncontrolled eye movement), ataxia (loss of coordination and balance), and confusion. Many patients have experienced toxicity before anyone checked their level.

Gingival hyperplasia — abnormal overgrowth of gum tissue; occurs in up to 50% of patients with long-term use; partly related to folate depletion.

What it depletes — the most aggressive depletion profile on this list

  • Vitamin D — phenytoin induces liver enzymes that break down vitamin D faster than it can be replaced; frank vitamin D deficiency develops in long-term users; causes calcium depletion and anticonvulsant osteomalacia (bone softening from mineral loss)
  • Folate — impairs absorption and increases degradation; depleted folate in women of childbearing age dramatically increases risk of neural tube defects (spinal cord birth defects) in any pregnancy
  • Vitamin B12 — neurological depletion; compounds cognitive side effects
  • Calcium — secondary to vitamin D depletion; weakens bones over time
  • Coenzyme Q10 (CoQ10) — essential for mitochondrial energy production in every cell; depletion causes fatigue and muscle weakness
  • Biotin — hair, skin, and energy metabolism

Topiramate

Topamax · Anticonvulsant / Migraine Prevention

"Dopamax" — Cognitive Effects

Topiramate works through several mechanisms including sodium channel blockade and GABA enhancement. It is also prescribed for migraines and increasingly for weight loss. The nickname "Dopamax" — used by patients and clinicians alike — reflects its most common complaint: significant cognitive dulling.

■ What patients actually experience

Cognitive impairment — word-finding difficulty (you know the word but can't retrieve it), slowed thinking, memory problems; often described as a "mental fog"; can be disabling.

Kidney stones — topiramate inhibits carbonic anhydrase, an enzyme involved in pH regulation; this increases urinary calcium and reduces citrate (a stone inhibitor); kidney stone incidence is 75 times the general population rate in some studies.

Birth defects — associated with cleft palate and cleft lip; the FDA issued a safety communication in 2011.

What it depletes

  • Folate — anticonvulsant class depletion
  • Biotin — impairs biotin-dependent enzymes
  • Coenzyme Q10 — mitochondrial energy; depletion compounds the fatigue and cognitive dulling

Gabapentin

Neurontin · Anticonvulsant / Nerve Pain — widely prescribed off-label

Dependence / Withdrawal

Gabapentin was approved for epilepsy but is now prescribed far more often for nerve pain, anxiety, insomnia, and fibromyalgia — uses that are off-label (not FDA-approved for that purpose). It binds to calcium channels in the brain to reduce neurotransmitter release. It is also producing a growing body of evidence around physical dependence and a withdrawal syndrome that the original prescribing conversation rarely mentions.

■ What is not routinely disclosed

Physical dependence — gabapentin produces dependence with regular use; stopping abruptly can cause a withdrawal syndrome including anxiety, insomnia, sweating, nausea, and in some cases seizures — including in people who were not prescribed it for seizures.

Sedation and cognitive impairment — dizziness, mental fog, and sedation are common; fall risk is significant in older adults.

What it depletes

  • Folate, B12, and vitamin D — anticonvulsant class depletion; all three support neurological stability

These are the most commonly prescribed anti-seizure medications. Not every drug is covered here. To look up your specific medication — nutrient depletions, interactions, black box warnings, and post-marketing side effects — visit the Drug Library.

The pattern across all of these

The medications deplete the nutrients that protect the threshold.

Magnesium regulates the NMDA receptor — the primary voltage gate on neurons. Folate is required for GABA synthesis and neurotransmitter methylation. B6 is the cofactor that builds GABA directly. Vitamin D protects neurological tissue and reduces neuroinflammation. CoQ10 provides the mitochondrial energy neurons need to maintain electrical stability.

Every antiepileptic drug on this list depletes one or more of those nutrients. Some deplete several. The longer the medication use, the more depleted the person becomes. The more depleted they become, the lower their threshold gets. A lower threshold may require a higher dose or additional medications — and the cycle continues.

This is not an argument against medication. It is an argument for managing the threshold from both directions at once: reducing what lowers it in the environment, and repairing what the medications have taken. The Action Plan tab addresses both.

My Action Plan

Organized by what to remove, what to add, and what to test. Check each as you complete it. Start with the removes — eliminating daily neurological burden is the first step.

Remove — Reduce Ongoing Burden

Water & Cookware

Switch to natural spring water (findaspring.com) or non-ozonated bottled spring water

Switch to glass or stainless steel bottles and cups — no aluminum cans for daily beverages

Replace nonstick pans with cast iron, carbon steel, stainless steel, or glass

Food & Supplements

Eliminate aspartame, sucralose, acesulfame-K from all food and drink

Eliminate MSG, hydrolyzed protein, yeast extract, "natural flavors" in processed food

Eliminate artificial food dyes (Red 40, Yellow 5, Yellow 6, Blue 1, Red 3)

Eliminate caffeine — coffee, energy drinks, pre-workout, tea, dark chocolate

Eliminate protein powders and pre-workout supplements

Eliminate synthetic multivitamins, Vitamin D3 supplements, folic acid

Switch to organic for the EWG Dirty Dozen produce items

Switch animal protein to pasture-raised, antibiotic-free; fish to wild-caught

Personal Care & Scented Products

Switch toothpaste: no fluoride, no NHA, no SLS, no TiO₂ — tooth powder or verified clean brand (EWG Skin Deep / Lead Safe Mama)

Discontinue prescription fluoride toothpaste (PreviDent 5,000 ppm) — discuss with dentist; daily mucosal fluoride load is a documented seizure threshold variable

Decline topical fluoride varnish at dental cleanings

Request epinephrine-free anesthetic for future dental work

Ensure seizure diagnosis is documented on dental chart — request extended X-ray intervals (18–24 months); decline CBCT unless clinically necessary; decline routine annual X-rays if oral health is stable

Before any contrast-enhanced neuroimaging: ask whether non-contrast imaging would answer the clinical question; if contrast is required, confirm your neurologist has been consulted

For fillings: ask whether the composite contains Bis-DMA — request Bis-DMA-free composite, ceramic, or zirconia; for crowns and inlays, ceramic and zirconia are the cleanest options

For children’s sealants: ask about glass ionomer-based sealants as a BPA-free alternative (Embrace WetBond is one); avoid resin-based sealants in seizure-prone children where possible

Switch shampoo, body wash, and deodorant to fragrance-free, paraben-free, aluminum-free formulations — check EWG Skin Deep; “unscented” often still contains masking fragrance

Switch to organic cotton unbleached menstrual products or a menstrual cup — conventional scented tampons and pads deliver dioxins and phthalate fragrance through vaginal mucosa (bypasses liver; enters circulation directly)

Switch to 100% cotton underwear — polyurethane elastic and PFAS-treated athletic fabrics are continuous phthalate and per/polyfluoroalkyl exposure against skin

Remove plug-in air fresheners from bedroom and main living areas — continuous aldehyde (including acetaldehyde, an NMDA activator) aerosolization into breathing space

Switch laundry detergent to fragrance-free (Branch Basics, ECOS Free & Clear, Seventh Generation Free & Clear) — eliminate scented dryer sheets and fragrance booster pellets entirely

Check all OTC medications for hidden caffeine, artificial dyes, and sweeteners

Hot Liquids & Plastics

Switch all hot beverages to glass mugs or ceramic cups — no single-use plastic, no polystyrene, no plastic-lined paper cups

Replace plastic travel mug with stainless steel (uncoated interior) or glass — "BPA-free" is not safer; BPS and BPF are direct replacements with equivalent estrogenic activity

Replace Keurig/pod brewing with glass or stainless pour-over, French press, or percolator — eliminates boiling water through plastic housing

Nicotine & Inhaled Toxins

Stop vaping — inhaled aldehydes (acetaldehyde = direct NMDA activator) are a seizure threshold variable every neurologist should know about and none do

Stop Zyn or nicotine pouches — high-dose buccal nicotine spike plus undisclosed additives absorbed through oral mucosa

Stop smoking — carbon monoxide reduces blood oxygen; cadmium and lead from tobacco inhaled daily and accumulate in brain tissue

Replace caffeinated sparkling water with plain spring water — check labels on anything marketed as a "water" in the water aisle

Environment

Router off at night — use a smart plug timer

Phone charged in another room overnight — not on the nightstand

All screens removed from bedroom — standby mode still emits

Replace LED bedroom lighting with incandescent or low-flicker bulbs for evening use

Blackout curtains — no external light sources during sleep

No VR headset use — documented seizure trigger in PSE; skull-contact EMF + close-range blue light simultaneously

No gaming in a dark room — no wireless headphones + controller + phone combination simultaneously

Open bedroom window during the day when possible — dilution is the most effective VOC management for mattress and furniture offgassing

Smart meter opt-out if meter is on or near bedroom wall (available most US states)

Fiber optic internet installed — the cable itself is non-emitting, but the ONT box, continuous Wi-Fi router, and switching transients on every circuit all add to household EMF load

Water damage or mold history in current or previous home — mycotoxins (chemical byproducts of mold) cross the blood-brain barrier and trigger neuroinflammation that directly lowers neurological stability

Lamotrigine + hormonal contraception — dose-change warning

If you take lamotrigine and start, stop, or change hormonal contraception — including the pill-free week — discuss lamotrigine dosing with your neurologist before any change. Starting oral contraceptives can reduce lamotrigine blood levels by 40–50%, dropping below therapeutic range. Stopping them causes a rebound rise that can reach toxic levels. This requires proactive dose management, not a reaction after symptoms appear.

Add — Rebuild What Was Depleted

Daily Foundations

Morning sunlight: eyes open, outdoors, within 30–60 minutes of waking — every day

Lateral sleep position: left or right side — supports glymphatic clearance of excess glutamate overnight

Consistent sleep/wake time: same time every day including weekends — circadian rhythm governs GABA/glutamate cycling

Bare feet on ground: grass, soil, or sand — even 10 minutes in the morning alongside sunlight exposure

Track waking BBT (basal body temperature): oral or underarm temperature before sitting up, same time each morning — tracks thyroid function baseline and catamenial seizure windows simultaneously; see History & Hormones for what to look for

Upper cervical structural assessment (if history of head injury, whiplash, or forceps/vacuum birth): craniosacral therapy, applied kinesiology, or quantum neurology — non-forceful, no machines or biofeedback; Blair technique or NUCCA for low-force upper cervical correction specifically

Food-Based Nutrients (by food source — not supplement)

These are food sources, not prescriptions. Skip any food you are allergic or sensitive to — multiple sources are listed for each nutrient so alternatives are available.

Magnesium: pumpkin seeds, dark leafy greens, dark chocolate (unsweetened), legumes, avocado, fatty fish

Whole food first. If supplementation is ever considered, avoid magnesium citrate, oxide, and other osmotic forms — they act as laxatives, draw water into the bowel, and deliver very little magnesium to tissue. Better-absorbed forms if a supplement is truly needed: magnesium glycinate (gentle, well-tolerated), magnesium malate (energy support), or magnesium threonate (crosses the blood-brain barrier). Topical magnesium chloride — applied to skin as a spray or flake bath — bypasses the digestive tract entirely and absorbs transdermally. Discuss with a knowledgeable practitioner before adding any supplement.

DHA: wild salmon, sardines, mackerel, pastured egg yolks, fish roe

Thiamine (B1): pork, liver, nutritional yeast, sunflower seeds, pine nuts

Zinc: oysters, red meat, pumpkin seeds, liver

Taurine: seafood (clams, scallops), meat, full-fat dairy

Folate (food form): liver, lentils, dark leafy greens, avocado — not folic acid supplement

Vitamin A (food form): liver, cod liver oil, pastured egg yolk, butter — not retinyl palmitate supplement

B6 (pyridoxine): poultry, wild tuna, pork loin, potatoes with skin, pistachios — rate-limiting cofactor for the glutamate→GABA conversion enzyme; depleted by oral contraceptives

Copper: liver, oysters, dark cacao (unsweetened), cashews, sunflower seeds — required for ceruloplasmin synthesis; without it iron cannot export from cells and accumulates in tissue

Stable glucose: protein + fat with every meal, no long gaps, no sugar cycling

After Antibiotics — Gut-Brain Rebuild

Raw sauerkraut (refrigerated, not shelf-stable) — 1–2 tablespoons with meals

Kimchi (fermented, not vinegar-based)

Kefir from pastured dairy (if tolerated)

Bone broth from pasture-raised animals

Test — Know Your Baseline

Labs to Request from Your Doctor

RBC Magnesium (not serum — serum is 1% of total body magnesium; RBC reflects tissue levels)

Full thyroid panel: TSH, free T3, free T4, reverse T3, TPO antibodies, thyroglobulin antibodies

Morning cortisol (8am blood draw) + DHEA-S

Serum iron, ferritin, TIBC, transferrin saturation

Serum copper + ceruloplasmin

Serum zinc

Retinol (Vitamin A) — required for ceruloplasmin synthesis; iron cannot export from cells without it

Methylmalonic acid (more sensitive than serum B12 alone)

Erythrocyte thiamine (B1) — more accurate than serum thiamine

Serum B6 (pyridoxine) + RBC folate — B6 is required to produce GABA; both depleted by most AEDs

Fasting insulin + glucose + HbA1c

25-OH Vitamin D (note: sunlight-derived and supplement-derived show the same level on this test; context matters)

AED drug level if on medication (to confirm therapeutic range)

Homocysteine (elevated = B12/folate/B6 deficiency signal; also cardiovascular and neurological risk marker)

MTHFR gene variants (C677T, A1298C) — one-time test; determines whether folic acid is safe or contraindicated

My change timeline — what I started and when:

Week 1 — I removed:

Week 2 — I added:

What I noticed changing:

Labs I requested (date):

Doctor Visit Prep

Bring this page to your appointment. Fill in before you go. The goal is to use your appointment time efficiently — you have specific questions and specific requests.

Appointment Details

Provider name

Appointment date

Appointment type

Current medications + doses

Since My Last Appointment

Number of seizures:

Dates and times:

Possible triggers I noticed before each:

Changes I've made since last visit:

Side effects from current medication:

Questions I Want Answered Today

1.

2.

3.

4.

5.

Labs I Am Requesting

Check the ones you want to ask for. Bring this list — it is faster than explaining from memory.

RBC Magnesium

Free T3, Free T4, TSH, reverse T3

TPO + thyroglobulin antibodies

Morning cortisol (8am)

DHEA-S

Serum iron, ferritin, TIBC, transferrin saturation

Serum copper + ceruloplasmin

Serum zinc

Retinol (Vitamin A) — required for ceruloplasmin synthesis and iron export

Methylmalonic acid (B12)

Erythrocyte thiamine (B1) — more accurate than serum thiamine

Serum B6 (pyridoxine) + RBC folate

Homocysteine

Fasting insulin + glucose + HbA1c

MTHFR gene variants (one-time test)

Questions my neurologist has not yet asked — that I want to raise:

Has anyone assessed my sleep for airway compromise or sleep-disordered breathing?

My seizures may have a hormonal pattern — can we track timing against my cycle? (women)

I have a history of head injury / difficult birth — has structural involvement been assessed?

Has upper cervical alignment (C1–C2) been evaluated? Misalignment can compress CSF flow and create brainstem tension — relevant with a history of whiplash, forceps/vacuum birth, or occipital symptoms. Non-forceful options include craniosacral therapy, applied kinesiology, quantum neurology, Blair technique, and NUCCA.

What nutrients does my current AED deplete, and how should I monitor for depletion over time?

If I need surgery in the future, which anesthetics are lower-risk for someone with my seizure history?

My fluoride exposure is significant — has this been considered as a contributing factor?

Before any new prescription is written for me: does this medication lower the seizure threshold, and is there an alternative that does not?

I have been prescribed high-strength fluoride toothpaste (5,000 ppm) for daily home use — is this appropriate given my seizure history and existing fluoride exposure from water and food?

Notes From This Appointment

What my doctor said:

Medication changes:

Labs ordered:

Follow-up date:

What I still need to follow up on:

30-Day Tracking Log

Track seizures, suspected triggers, sleep quality, and what you changed. Patterns emerge in 2–4 weeks. Bring this to your next appointment.

Trigger quick-reference — use this when filling in the "Suspected trigger" column

Environmental

  • — Smart TV / phone / router in bedroom (EMF all night)
  • — LED or fluorescent lighting in the evening
  • — Bluetooth headphones or earbuds
  • — VR headset or extended gaming session
  • — New fiber optic install / more WiFi devices added
  • — Mold exposure (home, car, workplace — current or past)
  • — Air fresheners, plug-ins, scented candles, laundry pellets
  • — Screen use within 1 hour of sundown

Metabolic & Nutritional

  • — Glucose crash (90–120 min after high-carb meal)
  • — Skipped meal or long gap between eating
  • — Post-exercise (1–2 hr window)
  • — Dehydration (urine dark yellow or amber)
  • — Demineralized water (RO / ZeroWater / ozonated bottled)
  • — MSG, aspartame, artificial dyes in food or drinks
  • — Caffeine (coffee, chocolate, energy drinks, sparkling water)
  • — Alcohol — including the 48-hr rebound window after drinking
  • — Protein powder with hydrolyzed protein or artificial sweeteners

Sleep

  • — Fewer than 7–8 hours total
  • — Stayed up past 10:30pm (cortisol second wind activated)
  • — Irregular bedtime or night shift
  • — Prone (face-down) sleeping position
  • — Room not dark — LED standby, street light, phone screen
  • — Room not cool / head not oriented north

Hormonal

  • — Premenstrual days 25–28 (progesterone withdrawal)
  • — Ovulation days 12–14 (estrogen peak)
  • — Hormonal contraception started, stopped, or pill-free week
  • — Xenoestrogen exposure — scented products, plastics, synthetic fabrics
  • — High stress / cortisol spike (argument, deadline, fright)
  • — Fasting or very low calories (rT3 shunting / cortisol spike)
  • — Thyroid medication dose change or missed dose
  • — Basal temperature below 97.8°F on waking (thyroid suppression or progesterone drop)

Structural

  • — Neck tension / upper trapezius tightness / forward head posture
  • — Mouth breathing (night or day) — jaw clenching, dry mouth on waking
  • — Recent head impact, whiplash, or neck strain
  • — Ocular migraine in the preceding hours or days
  • — Sleep position was prone after a nighttime seizure

Medical & Pharmaceutical

  • — New medication or dose change in the past 2 weeks
  • — Missed AED dose or inconsistent timing
  • — OTC medication (Tylenol, Benadryl, Dayquil, decongestants)
  • — Antibiotic — especially fluoroquinolone or carbapenem class
  • — Dental procedure (epinephrine anesthetic, nitrous, fluoride varnish)
  • — Vaccination in past 2–4 weeks — record vaccine name and date
  • — Fever or acute illness in the past week
  • — Steroid prescription (prednisone, methylprednisolone)

S = seizure · A = aura only · P = poor sleep · M = menstrual · Urine: C=clear · VPY=very pale yellow · PY=pale yellow · LG=light golden · DY=dark yellow · AM=amber · Mood: 1 (very low) – 10 (normal) · BBT: waking temp °F — below 97.8°F = thyroid flag; drop before period = catamenial window

Day / Date
Seizure / Aura (S/A/none)
Sleep hrs + quality
Suspected trigger (use list above)
What I changed today
Urine / Mood
BBT °F

30-day summary — patterns I noticed:

Seizures occurred most often when:

The change that seemed to help most:

What I still need to investigate:

Organized by category. These are starting points — always verify current formulations, as manufacturers change ingredients without notice.

Water

  • Natural spring water: findaspring.com — locate local springs, always test before drinking long-term
  • Non-ozonated bottled spring water: Mountain Valley Spring Water (glass bottles), Evian, Volvic — check label for "spring water" not "purified"
  • Containers: glass (Mason jars, Weck), stainless steel (uncoated interior) — no aluminum, no plastic
  • Remineralization: Quinton Marine Plasma — contact info@theundoctored.com

Toothpaste & Oral Care

  • DIY tooth powder: baking soda (daily) + pascalite clay (periodic/acute, adult use, work with practitioner — contains naturally occurring trace minerals including lead as listed by manufacturer); no essential oils in toothpaste (water-volatile, irritating to mucous membranes) — see theundoctored.com/toothpaste.html
  • Look up any brand: EWG Skin Deep — ewg.org/skindeep
  • Third-party tested brands: Mamavation — mamavation.com (search "toothpaste")
  • Lead/metal testing: Lead Safe Mama — leadsafemama.com
  • Avoid: fluoride, NHA/hydroxyapatite, SLS, TiO₂ (CI 77891), carrageenan, saccharin

Cookware

  • Best options: well-seasoned cast iron, carbon steel, uncoated stainless steel (18/10), glass (Pyrex), enameled cast iron (Le Creuset, Lodge)
  • Ceramic: only if certified lead-free — test with LeadCheck swabs if uncertain
  • Avoid: any scratched or chipped nonstick surface; PTFE/Teflon at any heat; PFOA-treated pans

Food — Finding Clean Sources

  • Pasture-raised meat + eggs: eatwild.com directory by state; Polyface Farms; US Wellness Meats
  • Wild-caught fish: Vital Choice (vitalchoice.com); local fishmongers; avoid farmed Atlantic salmon and imported farmed shrimp
  • Organic produce priority list: EWG Dirty Dozen — ewg.org/foodnews (updated annually)
  • No MSG check: Truthinlabeling.org — full list of hidden glutamate ingredient names

Ingredient Research Tools

  • EWG Skin Deep — ewg.org/skindeep — personal care products rated by hazard
  • EWG Food Scores — ewg.org/foodscores — packaged food ingredient analysis
  • Mamavation — mamavation.com — PFAS, heavy metal, and hormone-disruptor testing
  • Lead Safe Mama — leadsafemama.com — XRF testing database, candy, dishes, personal care
  • Open Food Facts — world.openfoodfacts.org — scan barcodes for full ingredient breakdown

Go Deeper on This Site

You can't consent to what you've never been told.

Every item in this audit is a documented mechanism — not a theory. This is not about doing everything at once. It is about knowing what is in your environment so you can make informed decisions about what to address first. That is what informed consent looks like.

theundoctored.com · Educational resource — not medical advice. Do not change or stop any medication without working with your prescribing physician.