Epilepsy — NZ Condition Guide | KiwiMeds

What is Epilepsy?

Epilepsy is a neurological condition characterised by recurrent, unprovoked seizures — episodes of abnormal electrical activity in the brain. A single seizure does not mean epilepsy. Epilepsy affects around 45,000 New Zealanders. Most people with epilepsy achieve good seizure control with medication.

Overview

Seizures take many forms. Focal (partial) seizures start in one area of the brain and may cause jerking of a limb, sensory symptoms, or altered awareness. Generalised seizures involve the whole brain — including absence seizures (brief staring spells), tonic-clonic seizures (convulsions with loss of consciousness, the classic “grand mal”), myoclonic jerks, and atonic (drop) attacks. Seizure first aid: keep the person safe, do not restrain, time the seizure, place in recovery position after convulsions stop. Call 111 if a seizure lasts more than 5 minutes.

Treatment in New Zealand

Anti-seizure medications (ASMs) are the mainstay of epilepsy treatment. Pharmac funds a range of ASMs including sodium valproate, lamotrigine, levetiracetam, carbamazepine, phenytoin, and topiramate. Around 70% of people with epilepsy achieve seizure freedom with medication. For drug-resistant epilepsy, epilepsy surgery, vagus nerve stimulation, and dietary therapy (ketogenic diet) are options.

NZ-Specific Information

Epilepsy NZ (epilepsy.org.nz) provides information and support. Driving restrictions apply to people with epilepsy in NZ — generally seizure-free for 12 months before driving. Discuss driving status with your neurologist. Sodium valproate should not be used in women of childbearing age without specialist oversight due to serious teratogenic risks.

Frequently Asked Questions

Can epilepsy be cured? Some forms of childhood epilepsy resolve with age. For adults, some people achieve seizure freedom with medication and may eventually be able to taper off medication. Can I take oral contraceptives with epilepsy medicines? Some ASMs reduce contraceptive pill effectiveness — discuss contraception options with your GP or neurologist.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications and should only be considered as adjunctive support under the guidance of a qualified healthcare professional. Always inform your GP or pharmacist before commencing any supplement, as interactions with prescribed medicines are possible.

• Vitamin D — Antiepileptic drugs (particularly enzyme-inducing drugs such as phenytoin, carbamazepine, phenobarbitone) significantly accelerate vitamin D metabolism, causing deficiency and increased fracture risk. Regular vitamin D monitoring and supplementation (1000–2000 IU/day) is standard practice for people on enzyme-inducing antiepileptics.
• Folate (B9) — Sodium valproate and other antiepileptics can reduce folate levels. People of childbearing potential on valproate or other antiepileptics require higher-dose folic acid (5 mg/day) pre-conception and in early pregnancy to reduce neural tube defect risk. Discuss with your neurologist.
• Calcium — Long-term antiepileptic drug use (particularly enzyme-inducing drugs) reduces bone mineral density via vitamin D metabolism interference. Adequate calcium supplementation alongside vitamin D reduces this risk.
• Magnesium — Magnesium has anticonvulsant properties (administered IV in eclamptic seizures). Oral supplementation may be beneficial in those with deficiency. Ensure adequate dietary intake.
• CAUTION: Herbal supplements — Many herbal supplements interact with antiepileptic drugs (AEDs). Evening primrose oil and Ginkgo biloba can lower seizure threshold. St John’s Wort significantly reduces levels of many AEDs. Never start any supplement without first consulting your neurologist or pharmacist.

Relevant Vaccinations

Individuals living with epilepsy may benefit from the following vaccinations. Please discuss your vaccination status with your GP or practice nurse, as eligibility and funding through the New Zealand National Immunisation Schedule may apply.

• Influenza (annual) — Fever from influenza is a major seizure trigger for many people with epilepsy. Annual vaccination is strongly recommended.
• COVID-19 — COVID-19 can cause fever and neurological inflammation triggering seizures. Maintaining COVID-19 vaccination is strongly recommended.
• CAUTION: Live vaccines and specific antiepileptics — Discuss vaccination plans with your neurologist, particularly if on immunosuppressive antiepileptics or if seizure control is actively being optimised.

Dietary Guidance

Evidence-based dietary modifications play a meaningful role in the management of epilepsy. The following foods are generally recommended as part of a balanced, condition-appropriate diet. A referral to a registered dietitian may be beneficial for personalised nutritional planning.

• Ketogenic diet (medical supervision only) — The ketogenic diet (high fat, very low carbohydrate) is a evidence-based medical nutrition therapy for drug-resistant epilepsy in children and increasingly in adults. It requires specialist dietitian supervision and neurologist oversight. It is not a general dietary recommendation but a medical intervention.
• Regular consistent mealtimes — Hypoglycaemia and fasting can lower seizure threshold. Maintaining regular meals and avoiding prolonged fasting is important for seizure stability.
• Adequate hydration — Dehydration and electrolyte imbalance are seizure triggers. Adequate water intake is especially important in hot weather and during exercise.
• Calcium-rich foods — Essential given the increased fracture risk from AED-related bone loss. Three servings of calcium-rich dairy or alternatives daily.
• Limit: alcohol — Alcohol lowers seizure threshold, disrupts sleep (a major seizure trigger), and interacts with many antiepileptic medications. Minimising or avoiding alcohol is strongly advised.

Related Conditions & Medications

Related conditions: Migraines.