Abstracts

RATIONALE: Stress is commonly perceived by patients with epilepsy as a trigger of seizures. To further elucidate the relationship between stress and seizures, we compared seizure frequency among patients with epilepsy in the Washington, D.C. area before and after the 9/11 terrorist attack.
METHODS: 46 patients with eplepsy and reliable documentation of seizure frequency were selected randomly out of the database of the epilepsy clinic of Georgetown University Hospital. Patients[ssquote] seizure diaries were reviewed retrospectively for three months and 2-3 months after the 9/11 attack for seizure frequency.Patients were interviewed and completed questionnaires concerning their activities during the day of the attack and the ensuing month, the effect of the attack on their own lives and on the lives of their family members and of friends, their perceived level of stress, and medication changes, compliance, sleep deprivation, alcohol and other drug use before the attack and for the month after the attack. Patients[ssquote] mood and arousal were assessed with the Beck Depression Inventory and the Hamilton Anxiety Scale. All evaluations were performed within three months the 9/11/01 attack. Patients absent from the Washington,D.C.area during the attack, patients with moderate or severe cognitive impairment and patients whose awareness of the 9/11 events was in doubt were excluded from the study.
RESULTS: 46 patients completed the survey. 19 (41%) patients did not perceive the 9/11 attack as stressful. 50% of patients experienced a mild or moderate degree of stress in association with the 9/11 events. 9% patients experienced a high degree of stress.5 (11%) of patients experienced both an increase in stress level and an increase in seizure frequency during the six weeks following 9/11 compared with the six weeks before 9/11. In two of these patients, increase in seizure frequency after the attack coincided with antiepileptic drug (AED) change. A second patient experienced her first seizure in three months 15 minutes after watching the attack on TV but had been AED-non-compliant for two weeks previously. Two subjects experienced an increase in seizure frequency during the six weeks starting with 9/11/01 events that was not associated with any other confounding factors such as AED non-compliance, sleep deprivation or alcohol use. By contrast, 25 patients (57% of all patients) stated that their seizures were triggered by stress, without showing a change in seizure frequency in their seizure diaries.
CONCLUSIONS: Stress is commonly perceived as a seizure trigger among patients with epilepsy. In this retrospective study, only 2/44 (5%) of all patients with epilepsy who were present in the area of a major environmental stress during the stressful events and 2/26 (8%) of patients affectedby this stress experienced an otherwise unexplained increase in seizure frequency. The study higlights the difference in the frequency of subjectively perceived influence of stress level on seizure occurrence with objectively documented influence of environmental stress on seizure occurrence.