Stress as a seizure precipitant: Identification, associated factors, and treatment options

Abstract

Stress is a common and important seizure precipitant reported by epilepsy patients. Studies to date have used different methodologies to identify relationships between epilepsy and stress. Several studies have identified anxiety, depression, and childhood trauma as being more common in patients with epilepsy who report stress as a seizure precipitant compared to patients with epilepsy who did not identify stress as a seizure precipitant. In one survey study it was found that a majority of patients with stress-triggered seizures had used some type of stress reduction method on their own and, of those who tried this, an even larger majority felt that these methods improved their seizures. Additionally, small to moderate sized prospective trials, including randomized clinical trials, using general stress reduction methods have shown promise in improving outcomes in patients with epilepsy, but results on seizure frequency have been inconsistent. Based on these studies, we recommend that when clinicians encounter patients who report stress as a seizure precipitant, these patients should be screened for a treatable mood disorder. Furthermore, although seizure reduction with stress reduction methods has not been proven in a randomized controlled trial, other important endpoints like quality of life were improved. Therefore, recommending stress reduction methods to patients with epilepsy appears to be a reasonable low risk adjunctive to standard treatments. The current review highlights the need for future research to help further clarify biological mechanisms of the stress-seizure relationship and emphasizes the need for larger randomized controlled trials to help develop evidence based treatment recommendations for our epilepsy patients.

Air pollution and risk of hospitalization for epilepsy: the role of farm use of nitrogen fertilizers and emissions of the agricultural air pollutant, nitrous oxide

“…Although others have acknowledged this relationship 19 , we must exert some hesitation with the underlying interpretation of our results. For example, the potential for bias in our results cannot be discounted, as the finding that the protective effect of farm use of nitrogen fertilizers against hospitalization for epilepsy may be associated with a more rural lifestyle that is less afflicted by stress, a recognized trigger for epilepsy 28 . However, this explanation is not consistent with our prior work showing a disproportionate burden in hospitalization for other mental health comorbidities, like ADHD (1997ADHD ( -2006, that occurs in these less populated areas, as we have discussed 7,9 .…”

Severe psychological distress among patients with epilepsy during the COVID‐19 outbreak in southwest China

“…Although results from the general public suggested that stress would increase the risk of epileptogenesis, especially in childhood, 38 the relationship between seizure onset of patients with epilepsy and stress was evaluated through different methods. The different results may come from potential confounders between stress and mental status, 39 such as bad habits under pressure, and patients' use of a stress reduction method if they feel stress triggers their seizures. 40 Whether our patients received multior monotherapy also did not influence this risk, consistent with the reported lack of association between multi-or monotherapy and prevalence of depression or anxiety among patients with epilepsy.…”

Stress and Seizures: Space, Time and Hippocampal Circuits

“…The figure highlights both discrete and overlapping temporal domains of these mediators, as well as their time-dependent actions on the network itself. Importantly, this type of temporal evolution is difficult to ascertain in human studies, which are typically based on questionnaires [2–6, [71–73]. In the aggregate, human studies implicate both acute and chronic stress, occurring over time-periods ranging from hours to weeks, as a seizure-promoting factor in people with epilepsy [71–76].…”