title: Clinical features of the pre-ictal state: mood changes and premonitory symptoms.
abstract: Identifying the pre-ictal state clinically would improve our understanding of seizure onset and suggest opportunities for new treatments. In our previous paper-diary study, increased stress and less sleep predicted seizures. Utilizing electronic diaries, we expanded this investigation. Variables were identified by their association with subsequent seizure using logit-normal random effects models fit by maximum likelihood. Nineteen subjects with localization-related epilepsy kept e-diaries for 12-14 weeks and reported 244 eligible seizures. In univariate models, several mood items and ten premonitory features were associated with increased odds of seizure over 12h. In multivariate models, a 10-point improvement in total mood decreased seizure risk by 25% (OR 0.75, CI 0.61-0.91, p=004) while each additional significant premonitory feature increased seizure risk by nearly 25% (OR 1.24, CI 1.13-1.35, p<001) over 12h. Pre-ictal changes in mood and premonitory features may predict seizure occurrence and suggest a role for behavioral intervention and pre-emptive therapy in epilepsy.
authors.affiliation: Comprehensive Epilepsy Management Center, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10467-2490, USA. sheryl.haut@einstein.yu.edu
authors.forename: Sheryl R
authors.initials: SR
authors.lastname: Haut
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.forename: Thomas
authors.initials: T
authors.lastname: Borkowski
authors.forename: Howard
authors.initials: H
authors.lastname: Tennen
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
mesh_terms: D000328:Adult; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000473:pathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D019964:Mood Disorders / Q000209:etiology*; D012640:Seizures / Q000503:physiopathology*; D012893:Sleep Wake Disorders / Q000209:etiology; D055815:Young Adult