Seizures and Proper Hydration
I should’ve known better, “Better late than never” -Idiom, It is better for someone to arrive or do something late than not to arrive or do it at all
As an endurance athlete for nearly 25 years you would think I would know the importance of proper hydration, but what I have learned is that it is even more critical when it comes to folks with Alzheimer’s. It never occurred to me since, Catherine, Cat, has not been running since April of last year. However, she is still very active and walks 6-8 miles a day.
Cat started having seizures over a year ago this past October. First time at this we ended up calling 911 and spent several hours in the hospital, while they ran a battery of tests.
Over the next 16 months she has had a total of 13 seizures. Most of them happen first thing in the morning with a few occurring later the same day. Most seizures last anywhere from 30 seconds to two minutes. A seizure lasting longer then five minutes is referred to as status epilepticcus and is considered a medical emergency. Her’s were lasting about 1 minute so there was no need to go back to the hospital, so I thought at the time.
While we were in California, visiting my son, Aaron, it was the first time that she had two in one day so off to the hospital we went. That time she spent 2 nights. She had not been out of bed anytime during those two days and she was now having serious problems eating.
A percentage of folks with Early Onset Alzheimer’s, (EOA), get seizures but in some cases they only have one in a lifetime. People with Alzheimer’s disease are estimated to have anywhere from a two- to six-fold increase in the risk of seizures compared to the general population. Over the course of the disease, anywhere from 10 percent to 26 percent will experience some form of seizure, both apparent and non-apparent, according to research from the Baylor College School of Medicine. While it is still unclear which mechanisms trigger seizures, there are certain characteristics that can place an individual at higher risk.
She was having what is known as Awakening tonic-clonic seizures: A seizure that occurs upon waking from sleep, causes uncontrolled jerking, all-body convulsions and stiffness of the arms, legs, or body. They are often accompanied by the abrupt loss of consciousness and/or bladder control.
A seizure is a sudden, uncontrolled electrical disturbance in the brain. While we tend to associate them with convulsions, seizures can sometimes manifest with subtle symptoms, such as changes in behavior, movement, feelings, or levels of consciousness. Another type of seizures are partial complex seizures in which you become unaware of your surroundings and engage in unconscious actions such as fumbling, lip-smacking, wandering, or picking at clothes. Another type, an absence seizure, is sometimes misdiagnosed as early-stage Alzheimer’s. An absence seizure is one in which an individual will suddenly “blank out” and wander aimlessly, a behavior referred to as amnestic wandering.
While it may seem reasonable to assume that the seizures are triggered by the degeneration of the brain, evidence strongly suggests that it is related more to beta-amyloid itself. Beta-amyloid is actually a fragment of a larger compound known as an amyloid precursor protein (APP). As APP is broken down, certain byproducts are released into the brain which can overexcite—and effectively overload—nerve pathways.
As the disease progresses, the accumulation of these byproducts can cause nerve cells to fire abnormally, triggering seizures. Individuals like Cat who have been diagnosed with Early-onset Alzheimer’s are associated with an increased likelihood of seizures, although the seizures themselves tend to develop in later-stages of the disease progression.
It was decided that she be put on anti-seizure medication, Levetiracetam or better known as Keppra. They started with 1000mg, twice a day. There is even some evidence that the anticonvulsant Keppra is approved for the treatment of epilepsy, and can help reverse some of the memory loss in people with Alzheimer’s disease. So at this point we were very hopeful but that was short lived.
The Common side effects of Keppra include: drowsiness, nervousness, abnormal behavior, aggressive behavior, agitation, anxiety, fatigue, hyperkinetic muscle activity irritability, mood changes.
Other side effects include: change in personality, combativeness, irritability, difficult urination, quick to react or overreact emotionally, rapidly changing moods, restlessness, sleepiness or unusual drowsiness, unusual tiredness or weakness, itching feeling, clumsiness or unsteadiness, increase in body movements, loss of bladder control, mood or mental changes, outburst of anger, shakiness and unsteady walk, or other problems with muscle control or coordination
Incidence not known: constipation, difficulty with moving, general feeling of tiredness or weakness, increased thirst, large, hive-like swelling on the face, pains in the stomach, side, or abdomen, possibly radiating to the back, pinpoint red spots on the skin, skin rash, encrusted, scaly, and oozing, twitching, twisting, or uncontrolled repetitive movements or jerking of the arms, Loss of strength or energy.
That was the partial list but all the ones Cat experienced while on Keppra. We tried lesser dosages but either she would have a seizure or the side effects were intolerable. Listening to a Podcast by the renowned, Teepa Snow, on the topic of medications for Seizures, within the Alzheimer’s community, she said, “Damn if you do, Damn if you don’t.
After 6 months we took her off of Keppra and like clock work the seizures returned within 5 days. I looked into other medications but they all had far worse side effects including possible Kidney damage.
The diagnosis of Alzheimer’s-related seizures is often an inexact science and one that may require input from a specialist known as epileptologist. While an imaging study known as an electroencephalogram (EEG) can be used to confirm seizure activity, it has its limitations. An EEG measures electrical activity in the brain and, as such, can only definitively diagnose seizures if abnormalities occur during the test. As a result, only between 3 percent and 10 percent of Alzheimer’s-related seizures are diagnosed with EEG alone.
With that being said, an EEG can sometimes detect abnormal electrical activity, known as epileptiform discharges, 24 to 48 hours after a seizure. While neuroimaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI), can detect changes in the brain consistent with Alzheimer’s, they cannot tell us whether those changes are consistent with seizures. The same applies to genetic blood tests, which are more useful in supporting a diagnosis rather than making one.
We thought about going to a seizure clinic but we had an EEG done while in San Diego and they needed her to be sleep deprived to insure an accurate result. The one done in San Diego did not show any brain bleeds or evidence of a stroke so I decided not to put Cat through that again.
After Keppra I did some research and thought that CBD might help prevent them or at least lessen the frequency of them. CBD is short for cannabidiol, which is a chemical found in marijuana. It is not the same as tetrahydrocannabinol (THC), the chemical in cannabis that is responsible for the “high” feeling people get from marijuana. The Endocannabinoid system, ECS, regulates the sleep/wake cycle and “Cannabinoid” comes from “cannabis,” and “endo” is short for “endogenous,” which means that it is produced naturally inside of your body. So Endocannabinoid simply means cannabis-like substances that naturally occur inside us.
Because cannabis products can stimulate activity of the ECS, they’re obvious targets for potential treatments, and a ton of research is going on around the world. Cannabinoids are being researched as potential treatments for all kinds of conditions, not just those involving endocannabinoid deficiency.
Some of the illness they’re being researched for include:
- Alzheimer’s disease
- Cardiovascular disease
- Neurological, neurodegenerative, neurodevelopmental, and psychiatric illnesses
- Acute and chronic kidney disease
- Autoimmune diseases
- Chronic inflammatory diseases
- Chronic pain conditions
With all this research in hand I thought I had found a possible answer. Unfortunately Cat only went a month without a seizure and the down side was it did make her a bit more agitated.
With that rabbit hole dug up and found to be empty the research continued. This time in the direction of starting a Keto diet. Research had shown to decrease the frequency of epilepsy but if not done correctly could cause more complications and possible Kidney damage. I did run across a statement about how a Keto diet can cause dehydration. Following the rabbit this time about dehydration I ran across this article.
CAN DEHYDRATION IMPAIR COGNITIVE FUNCTION? January 10, 2020 Betsy Mills, PhD
We often hear the adage about the importance of drinking eight glasses of water a day to keep our bodies healthy, but how about our brains? The adult human body contains around 60% water. All the cells in the body, including our brain cells, depend on this water to carry out essential functions. Therefore, if water levels are too low, our brain cells cannot function properly, leading to cognitive problems.
The brains of dehydrated adults show signs of increased neuronal activation when performing cognitively engaging tasks, indicating that their brains are working harder than normal to complete the task. In healthy young adults, this additional effort typically manifests as fatigue and changes in mood, but in populations with less cognitive reserve, such as the elderly, this can lead to a decline in cognitive performance. Performance on complex cognitive tasks that require high levels of brain power is most likely to decline due to the strain of dehydration. A meta-analysis of 33 studies including a total of 413 participants found that dehydration corresponding to more than a 2% reduction in body mass (e.g. 3 lbs. of fluid loss in a 150 lb. person) was associated with significant impairments on attention, executive function, and motor coordination .
Women of all ages are more sensitive to the effects of dehydration, but elderly women are especially vulnerable. A study examining the hydration status of 2,506 adults over age 60 found that women with inadequate levels of hydration showed worse performance on cognitive tasks related to attention and processing speed. The performance of dehydrated men also declined, but to a lesser degree.
In young women, cognitive deficits can be readily reversed by replenishing fluids, while in the elderly, the prolonged cellular stress of dehydration may promote brain pathology and continued cognitive decline. A study assessing the cognitive function and hydration status of 1,091 people over age 65 found that dehydrated individuals were at higher risk for dementia, while individuals with dementia were at higher risk for dehydration. Additional studies indicate that dehydration can accelerate cognitive decline in people with dementia.
Decreased water levels in cells can cause proteins to misfold and prevent the clearance of these toxic proteins, causing them to build up in the brain. While it is clear that dehydrated cells are associated with brain dysfunction, it is not yet known whether dehydration is a cause or an effect of dementia.
In addition to being most vulnerable to dehydration related cognitive decline, the elderly are also at higher risk for dehydration. The levels of water stored in the body decline with age due to changes in body composition, namely the loss of muscle and gain of fat. Muscle tissue provides a large reservoir of water since it is made up of nearly 80% water, while fat tissue has a much lower water content around 10%. The lower percentage of muscle mass in women may contribute to their increased sensitivity to dehydration.
The elderly are also less likely to notice they are dehydrated. The brain becomes less sensitive to the thirst sensor with age, so thirst is a less reliable indicator of hydration status in this population. Due to changes in kidney function with age, the elderly are less able to concentrate urine to conserve water and regulate sodium levels, putting them at higher risk for complications related to dehydration or overhydration. Furthermore, it is more difficult to accurately diagnose dehydration in older adults. Traditional physical signs of dehydration, saliva tests, and urine tests are often inaccurate or misleading due to the presence of other chronic conditions. Blood tests are the only reliable indicators of dehydration in the elderly.
To keep your brain adequately hydrated, it is recommended that women consume 2 to 2.7 liters (8 to 11 cups) and men consume 2.5 to 3.7 liters (10 to 15 cups) of fluids per day, though individual needs may vary depending on activity level and medication use. It can help to develop a schedule to keep track of daily fluid intake. It is important to keep in mind that cognitive function can also be impaired by overhydration. Overhydration can lead to drop in sodium levels that can induce delirium and other neurological complications, so fluid consumption should not vastly exceed medically recommended guidelines.
Diet and exercise are also important components to remaining hydrated. The hydration guidelines refer to the consumption of all fluids, not simply how many glasses of plain water we drink per day. However, it is counterproductive to start drinking more beverages laden with sugar or artificial sweeteners, since they have their own health risks. Our bodies obtain water from multiple nutritional sources, including many healthy mineral rich foods, so it is possible to get adequate levels of hydration by incorporating more water rich foods into your diet. Some nutritious water rich foods include melon, oranges, berries, lettuce, cucumbers, and tomatoes. You can also preserve your body’s stored water content through strength conditioning exercises which build muscle.
Being dehydrated is one possible cause of electrolyte imbalances. This refers to changes in the balance of minerals known as “electrolytes” in your body. Electrolytes have many important roles and contribute to nutrition, waste management, and organ function. Due to this, electrolyte imbalances can significantly impact health, including the function of the brain. As a result, sometimes severe dehydration leading to electrolyte imbalances may cause a provoked seizure as a symptom.
With all this information in hand off I went to dig up yet another rabbit hole. But first I had to put a detailed plan together. That is the pilot mentality shining thru. The easy part was during the day but since her seizures were when she first woke up what to do overnight and first thing in the morning.
During our marathon days we were mostly Gatorade type folks with the occasional off brand that was being handed out at the marathon expos. Just like anything else I had to do my research on what drink mix would work best. It had to be something Cat would not hesitate to drink.
I found a product called Liquid IV. It turns out my daughter, Mariah, used it when she was pregnant to keep hydrated. It touts that it has twice the hydration power of water alone. It also has a number of electrolytes crucial to keep seizures at bay.
On the electrolyte front I also found a product in gummy form, Olly, Post-Game Recover, that I could get her to chew as soon as she woke up to immediately boost the electrolytes. Of course I had to go buy a humidifier since it was winter here in Atlanta and with the heat running overnight it would add to keeping us both hydrated.
Early on I could get Cat to drink during the day with no problem but first thing in the morning was becoming an issue. More research showed the benefits of Green tea so decaffeinated Green tea and Chamomile tea was added about 50/50 with some honey. I then had no problem to get her to stay hydrated all during the day and night. Between this and a fruit smoothie poured over her granola and drinking the rest with her breakfast she is getting about 1.5-2 liters of liquid a day.
I don’t use just any water, however, we have been using Fifi water since it contains Silica which also promotes brain health. It also has a PH of 7.7 which aides in water absorption to all your cells. As they say, so far so good. It has been over two months since her last seizures but I did realize there are two possible flaws to my plan of action.
First one being I have to be awake prior to her waking up so I can start having her drink before the tremors which turn into a seizure take hold. Secondly not every morning Cat is in the mood to drink as much as she should. So far I have been able to stay ahead of the curve but I resolved myself with the fact that it is not, if she will have another seizure, but when.
I am actually okay with that eventuality as long as I can push each of them off as long as possible. They really kick us both in the gut. As I mentioned previously Cat disease progression is like a sine wave. Some days are much better than others but for several weeks after a seizure we have to climb back out of the deep hold it puts us in.
I realize this blog entry was a bit lengthy but I wanted to give each of you as much background and context as possible. I am sure that this will not work for everyone facing seizures in general or those with Alzheimer’s in particular but I must say, aside from the possible anti seizure benefits, keeping Cat hydrated has shown some improvements in her overall cognition. Just the other day she walked up to me and in a voice as clear as a bell she said that, “I was really pretty.” Those are the moments I live for.
I do have an abridged version of my book, Running All Over the World, Our Race Against Early Onset Alzheimer’s hitting your favorite book store shelves, May 2nd. This version is being published by Morgan James Publishing and you can preorder now by going, Here.
Thanks
Tony and Cat
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