Abstracts

Stress is an often reported, but rarely studied trigger factor for seizures. Using diary data, we explored the population and within person effects of stress on the occurrence of seizures. Subjects 18 yrs or older with localization related epilepsy were recruited from the Epilepsy Management Center and the neurology clinics at Montefiore Medical Center. Eligible subjects had at least 1 seizure within the prior 12 months and the ability to self-maintain a daily diary. Diary data included dates and times of all seizures, and daily stress, measured on a 10 point ordinal scale (1 being least, 10 being highest stress). We modeled the association of stress on a given day as a predictor of seizures over the subsequent 24 hrs using mixed-effects logistic models for the entire population, and logistic regression models for individuals. Sixty four subjects maintained seizure diaries with daily stress levels for [gt]1 month and up to one year (median: 246 diary days) for a total 15,806 person days of diary data. Increases in recorded stress levels were associated with increased risk of seizures in the subsequent 24 hour epoch (p[gt]0.000); A three unit increase in stress was associated with a 32% increase in the relative odds of seizure (OR 1.32 (95% CI 1.22-1.40). These findings were independent of hours of sleep. Within-person significance for stress and seizure risk was demonstrated for 25% of subjects at 0.10 level, and 20% of subjects at 0.05 level. Elevations in daily stress measurements were significantly associated with increased risk of seizure in the subsequent 24 hours, independent of hours of sleep. This association was significant for at least 20% of individual subjects. This subgroup may be particularly vulnerable to the effects of stress. Further studies will explore the mechanisms of this stress effect, and examine potential behavioral interventions to uncouple stress from seizure risk. (Supported by K23NS02192 (P.I. Dr. Haut).)