Stress and epilepsy: a patient perception survey☆
Introduction
Many patients with epilepsy report that stress exacerbates their seizures, but the association between stress and epilepsy is difficult to study. There are few objective measures of stress, and other factors such as fatigue and sleep deprivation must be considered [1], [2]. Nonetheless, if it can be reliably demonstrated that stress as an isolated factor does increase seizure frequency, then this may lead to a greater use of alternative treatments in epilepsy, including a variety of stress reduction modalities. As a preliminary step to a planned treatment trial of alternative therapies for epilepsy, this study was performed to explore and delineate patients’ perceptions of stress and specific stressors as related to seizure control.
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Patient selection
Patients followed in the Epilepsy Management Center of Montefiore Medical Center were considered for inclusion in the questionnaire study if they met the following criteria: duration of epilepsy >1 year; age ⩾18; ability to read and complete an English or Spanish questionnaire. Of 96 eligible participants, 3 declined to participate, and 4 questionnaires were later excluded due to missing data.
Stress and seizures
Patients’ perceptions about the association between seizures and stress were addressed: “Have you ever
Demographic and epilepsy data
Eighty-nine subjects completed the questionnaire. Gender: female 59.5%; male 40.5%. Age: mean 38.2; range 18–25 (21.3%), 26–34 (19.1%), 35–50 (42.7%), and >50 (16.9%). Site of care: seizure clinic (46%), faculty practice (54%). Epilepsy classification: localization-related (87.6%), idiopathic/primary generalized (12.4%). Degree of seizure control: well-controlled (32.6%), not well-controlled (67.4%).
The association between stress and seizures
Overall, 57 of 89 (64%) subjects believed that some of their seizures were related to stress.
Discussion
Most studies of seizure precipitants identify stress as a frequent self-reported precipitant. Both stress levels [7] and major life events [8] have been reported in association with increased seizure frequency. Unfortunately, stress often coexists with other potential seizure precipitants, and the evaluation of stress as an independent factor is difficult, as was demonstrated by a questionnaire study of seizure precipitants by Mattson in 1991 [2]. Of 177 patients who completed a detailed survey
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Supported by NIH K23 NS02192-03 (P.I. Dr. Haut). Presented in part at the American Epilepsy Society Annual Meeting, December 2001, Philadelphia, PA, USA.