Abstracts

RATIONALE: The importance of stress in precipitating seizures in patients with epilepsy is ill defined. A clinical impression suggests that stress may trigger seizures, but the few studies that have examined the issue have found a wide range, 3-60%, of patients to have stress-sensitive seizures. This study sought to determine the frequency of association of perceived stress with seizures in patients with localization-related epilepsy (LRE); and to determine the effect of seizure locus on this association. METHODS: 116 consecutively evaluated patients with LRE (> 14 years old, without severe cognitive impairment; 72 women, 44 men) completed a questionnaire relating subjectively perceived stressful events (SPSE), sleep patterns, AED compliance and alcohol intake to seizures at initial evaluation and at follow up visits. Epilepsy evaluation included EEG and, where normal, sleep deprived EEG or LTEEG with minisphenoidal electrodes, and MRI. Patients with possible non-epileptic seizures were excluded. Data were analyzed using ?2, ANOVA and logistic regression analysis to determine whether seizure locus and laterality, gender, age at seizure onset, seizure duration and severity, AED non-compliance, sleep deprivation, EtOH use and depression were related to seizure occurrence after stress. RESULTS: In 27% of patients there was no relationship or an uncertain relationship between SPSE and seizure occurrence. In 63% of patients, > 10% of seizures were related to SPSE - in 38% > 35% of seizures, in 19% > 50% of seizures and in 13% > 75% of seizures were stress-related, including 8% (9/116) of patients in whom 85-100% of seizures followed SPSE. Seizures followed SPSE with a latency ranging from minutes to days; in 3/116 patients, seizures occurred during relaxation after an SPSE. Seizures followed SPSE in 31/42 patients with left-sided TLE, in 9/12 patients with bitemporal TLE and in 8/19 patients with right-sided TLE (LTLE vs RTLE ?2: p=0.05). Gender, seizure severity, age at seizure onset, AED non-compliance and depression were not related to seizure occurrence after stress. CONCLUSIONS: Stressful events are commonly perceived as a seizure trigger by patients with LRE, particularly by patients with LTLE.