Seizure precipitants in a community-based epilepsy cohort

Abstract

Epileptic seizures can be provoked by several factors. Better understanding of these factors may improve a patient's sense of control and could reduce seizures. In daily practice, the recognition of seizure precipitants relies heavily on clinical or video-EEG evidence, which can be difficult to obtain. Studies of seizure provocation are largely based on selected hospital-based patient populations, which may lead to biased occurrence estimates. Self-reported seizure precipitants are rarely studied, yet are necessary to understand the experiences of patients and improve epilepsy management. We performed a cross-sectional community-based study of 248 epilepsy patients, selected by pharmacy records of anti-epileptic drug use. Self-reported seizure precipitants and potential associated characteristics were assessed using questionnaires. Almost half of all patients (47 %) reported one or more seizure precipitants, of which stress, sleep deprivation, and flickering lights were the most common. In this community-based setting, light-provoked seizures were especially frequent compared to the literature. Idiopathic generalized epilepsy (IGE), a lower age at seizure onset, and having auras or prodromes were found to be important independent prognostic factors associated with provoked seizures. IGE and a younger age at seizure onset have been linked to provoked seizures in earlier reports. The finding of auras or prodromes as a prognostic factor was unexpected, though case reports have described provoked seizures in patients having auras. Assessment of these factors may facilitate the early recognition of seizure precipitants in daily clinical practice. This is important for the optimization of epilepsy management for a large group of patients, as provoked seizures are expected to occur frequently.

The impact of sleep loss on the facilitation of seizures: A prospective case-crossover study

“…The notion that sleep loss may have a specific effect on neuronal excitability is in line with a range of previous clinical and EEG studies (Aird, 1983;Antebi and Bird, 1993;Badawy et al, 2006;da Silva Sousa et al, 2005;Ferlisi and Shorvon, 2014;Frucht et al, 2000;Huber et al, 2013;Wassenaar et al, 2014). Sleep deprivation facilitates interictal epileptiform discharges, not only during non-REM sleep, but also during wakefulness .…”

“…Studies trying to identify various seizure triggers have predominantly been performed in outpatient clinics (Antebi and Bird, 1993;Ferlisi and Shorvon, 2014;Wassenaar et al, 2014;) …”

“…There are still no conclusive clinical data showing to what extent and magnitude each of these factors trigger seizures. (Aird, 1983;Antebi and Bird, 1993;Ferlisi and Shorvon, 2014;Wassenaar et al, 2014). Although sleep deprivation has been found to activate epileptiform EEG in several studies (Fountain et al, 1998), it has been debated whether isolated sleep loss promotes seizures .…”

“…suggest sleep deprivation as a seizure trigger (Aird, 1983;Antebi and Bird, 1993;da Silva Sousa et al, 2005;Ferlisi and Shorvon, 2014;Frucht et al, 2000;Wassenaar et al, 2014). A study combining transcranial magnetic stimulation and EEG suggested that the excitability of the human frontal cortex progressively increased with time awake and decreased after sleep recovery (Huber et al, 2013).…”

Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology?

“…Patients with epilepsy commonly report stress as a precipitating factor for seizures (Frucht et al, 2000;Haut et al, 2003Haut et al, , 2007Nakken et al, 2005;Ferlisi and Shorvon, 2014;Wassenaar et al, 2014) and stress is associated with increased seizure frequency (Temkin and Davis, 1984;Neugebauer et al, 1994). In a tertiarycare facility (n¼ 400), stress was the most widely (30%) identified precipitating factor across different types of epilepsy, although patients with TLE were the most affected (46%) (Frucht et al, 2000).…”