Abstracts

Rationale: Stress has been shown to be one of the most common precipitants of seizures. Significant stressors can include childhood trauma, underlying generalized anxiety, and/or depression. It is, however, not known if these stressors play a role in seizure precipitation. This study was developed to evaluate epilepsy patients with stress-triggered seizures and controls, family members in the same environment, by using validated scales to examine the relationship between stress and childhood trauma, generalized anxiety, and depression, respectively. Understanding these relationships can help treat patients with stress-triggered seizures. Methods: The study used an online Redcap survey which included the Childhood Trauma Questionnaire (CTQ), the Generalized Anxiety 7-Item Scale (GAD-7), and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Subjects were selected if they were >/= 18 years old, English speaking, had internet access, and diagnosed epilepsy without non-epileptic events. Each subject was contacted by phone to participate in the survey if they had indicated by history that they have stress-triggered seizures. The control group was formed by family members of the patients who live in the same household. All subjects signed informed consent. Each patient and control was scored using the standardized scale for each individual survey and then the data was compared using a Mann-Whitney U-value test. Results: There were a total of 54 patients with stress-triggered seizures and 21 controls. 92.6% of the epilepsy patients reported that they can relate at least one example of a time when stress lasting days to months made seizures more likely, and 72.2% could identify an acute stressor that caused a seizure. 59.2% of the epilepsy patients reported a history of depression or anxiety, compared to 42.85% of the control group. There was a statistically significant difference in scores for the GAD-7 scale, p=0.0221, where the epilepsy group had significantly higher levels of anxiety than the control group. 48% of patients in the epilepsy group scored above "minimal anxiety" versus 28% of controls. The NDDI-E scale showed that 39% of patients with epilepsy met criteria for depression, whereas 20% of controls met criteria, although there was not a significant difference between the groups. Also, the CTQ scale showed that the highest areas of abuse among both the epilepsy subjects and controls were in emotional and physical neglect. Conclusions: Patients with stress-triggered seizures are more likely to have higher levels of anxiety (statistically significant difference) and depression. Abuse and neglect are also common among this population of seizure patients, in particular emotional and physical neglect. The similarities between the epilepsy patients and the controls on the CTQ scale may be reflective of them being in the same environment. Anxiety and depression comorbidities may be contributing to the seizure burden in this patient group; it will be important to determine if their treatment will help improve seizure control.