title: Does Saint Nicholas provoke seizures? Hints from Google Trends.
abstract: OBJECTIVE
  Stress is the most often reported seizure-precipitant in epilepsy. As most evidence for the relation between stress and epilepsy is derived from human self-reports, observational studies including a larger part of the population could provide additional proof. A stressor often reported to increase seizure frequency in children with epilepsy in the Netherlands is the national celebration of Saint Nicholas' eve (December 5) and the weeks before; this is the main period of festivities for children in this country. To study the relation between stress and epilepsy, we analyzed epilepsy information-seeking behavior on the Internet, an indirect measure of seizure frequency, around this national children's celebration.
  
  
  METHODS
  Google Trends was used to extract relative search percentages for 'epilepsy' on Google in the Netherlands, the United States, and the United Kingdom between 2004 and 2013. Relative search percentages during the Saint Nicholas period were compared with baseline.
  
  
  RESULTS
  Epilepsy searches increased by 14% in the Saint Nicholas period compared with baseline (p<0.001). This effect was not found for searches performed in the same period in the United States or the United Kingdom, countries where this holiday is not celebrated.
  
  
  CONCLUSIONS
  The increase in epilepsy information-seeking behavior in the Saint Nicholas period is possibly caused by an increased occurrence of epileptic seizures. This underscores the potential of health information-seeking behavior on the Internet to answer clinically relevant research questions and provides circumstantial evidence for a relation between stress and the occurrence of epileptic seizures.
authors.affiliation: Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands. Electronic address: J.S.vanCampen-4@umcutrecht.nl.
authors.forename: Jolien S
authors.initials: JS
authors.lastname: van Campen
authors.affiliation: Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: van Diessen
authors.affiliation: Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Biomedical MR Imaging and Spectroscopy Group, Image Sciences Institute, University Medical Center Utrecht, The Netherlands.
authors.forename: Willem M
authors.initials: WM
authors.lastname: Otte
authors.affiliation: Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
authors.forename: Marian
authors.initials: M
authors.lastname: Joels
authors.affiliation: Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
authors.forename: Floor E
authors.initials: FE
authors.lastname: Jansen
authors.affiliation: Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
authors.forename: Kees P J
authors.initials: KP
authors.lastname: Braun
mesh_terms: D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000453:epidemiology; D005260:Female; D006693:Holidays; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet / Q000706:statistics & numerical data / Q000639:trends*; D001523:Mental Disorders; D009426:Netherlands; D012107:Research Design; D012640:Seizures / Q000453:epidemiology*; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D006113:United Kingdom; D014481:United States
keywords: Epilepsy; Holidays; Internet; Search queries; Seizures; Stress