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.

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.

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)

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

I rarely drink plain water throughout the day

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

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)

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 take a daily multivitamin

I supplement with Vitamin D (D3 capsules or drops)

I use fluoride toothpaste (most commercial brands)

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

My child swallows toothpaste (under 8 years old)

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

I have taken a fluoroquinolone antibiotic (Cipro, Levaquin, Avelox) in the past 2 years

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

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 (or my child) use screens within 1 hour of bedtime

I (or my child) game in a dark room with the screen as the main light source

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

I (or my child) use a gaming chair with built-in speakers or wireless mic

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

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

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

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) — anticholinergic burden; Benadryl lowers seizure threshold at regular doses

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

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"

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 — 15x toothpaste concentration) at my last dental cleaning

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

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 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 (mepivacaine plain or lidocaine without epi)

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:

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

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

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

Switch toothpaste: no fluoride, no NHA, no SLS, no TiO₂ — tooth powder or verified clean brand

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

Decline topical fluoride varnish at dental cleanings

Request epinephrine-free anesthetic for future dental work

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

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

Add — Rebuild What Was Depleted

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

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

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

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

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

Kimchi (fermented, not vinegar-based)

Kefir from pasture dairy (if tolerated)

Bone broth from pasture-raised animals

Test — Know Your Baseline

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

Vitamin B12 (methylmalonic acid is more sensitive than serum B12 alone)

Fasting insulin + glucose (HbA1c alone insufficient for glucose dysregulation pattern)

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.

Provider name

Appointment date

Appointment type

Current medications + doses

Number of seizures:

Dates and times:

Possible triggers I noticed before each:

Changes I've made since last visit:

Side effects from current medication:

1.

2.

3.

4.

5.

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

TPO + thyroglobulin antibodies

Morning cortisol (8am)

DHEA-S

Serum iron, ferritin, TIBC

Serum copper + ceruloplasmin

Serum zinc

Methylmalonic acid (B12)

Homocysteine

Fasting insulin + glucose

MTHFR gene variants

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?

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?

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.

S = seizure occurred  ·  A = aura only  ·  P = poor sleep  ·  M = menstrual (circle where relevant)

Day / Date
Seizure / Aura (S/A/none)
Sleep hrs + quality
Suspected trigger
What I changed today

30-day summary — patterns I noticed:

Seizures occurred most often when:

The change that seemed to help most:

What I still need to investigate:

Clean Alternatives — Where to Look

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

  • 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
  • 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
  • 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
  • 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
  • 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

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.