Abstracts

Rationale: Up to 50% of people with epilepsy believe stress is a trigger for seizures yet little is known about the specific stressors, the timing of the stressors and other associated factors for stress-triggered seizures. We surveyed a large epilepsy practice to identify patients who felt seizures were sometimes triggered by stress and determined whether other epilepsy or mood factors were associated with stress-triggered seizures. Methods: Sequential patients in the outpatient clinics of the Epilepsy Center of the University of Cincinnati Neuroscience Institute were asked: 1) were seizures sometimes triggered by stress; 2) could they identify a specific instance where stress lasting days to months made seizures more likely; 3) could they identify a specific instance where an acute stress lasting minutes to hours made a seizure more likely; and 4) if they had tried some type of stress reduction and whether they thought the stress reduction worked to reduce seizures. Subjects were also asked about ability to predict seizures. Excluded patients had cognitive impairment making them unable to complete the questionnaire or elected to not participate. All subjects signed informed consent. Midway through the study, data were gathered on a control population of subjects who thought stress played no role in their seizures (stress (-)). Data on seizure type, history of and treatment for depression, depression (NDDI-E) and anxiety (GAD-7) screening scores (these instruments are administered to all patients at each visit in the clinic), demographics and seizure types were gathered. Results: This preliminary analysis is based on 203 stress (+) subjects and 28 stress (-) controls. Among stress (+) subjects, 85% endorsed chronic stress as a seizure trigger; 68% endorsed acute stress as a trigger. In stress (+) subjects, some type of relaxation or stress reduction treatment was used by 57% and of those who tried this treatment, 88% thought it improved seizures. Interestingly, 25% of stress (-) subjects tried relaxation or stress reduction and 71% thought seizures improved. Comparing stress (+) and stress (-) subjects in a univariate analysis the following characteristics were associated with stress (+) subjects (odds ratio >1 including 95% CI): history of depression, higher NDDI-E, higher GAD-7. In a multivariable logistic regression, only GAD-7 score and seizure prediction was associated with stress (+). Stress (+) subjects were more likely to believe they could at least occasionally predict seizures (51.8% vs. 14.3%; OR 8.6, p=.0005). Conclusions: Stress-triggered seizures are common, may be associated with chronic or acute stress, and are associated with higher depression and anxiety scores. Patients who endorse stress-triggered seizures are more likely to believe their seizures can be predicted. Many patients have tried stress reduction and the large majority of those who tried believe it helped reduce seizures. A randomized, controlled trial of stress reduction methods in medication resistant epilepsy is indicated.