title: Characteristics of people with self-reported stress-precipitated seizures.
abstract: OBJECTIVE
  Stress is the most common patient-reported seizure precipitant. We aimed to determine mood and epilepsy characteristics of people who report stress-precipitated seizures.
  
  
  METHODS
  Sequential patients at a tertiary epilepsy center were surveyed about stress as a seizure precipitant. We asked whether acute (lasting minutes-hours) or chronic (lasting days-months) stress was a seizure precipitant, whether stress reduction had been tried, and what effect stress reduction had on seizure frequency. We collected information on antiepileptic drugs, history of depression and anxiety disorder, prior or current treatment for depression or anxiety, and scores on the Neurological Disorders Depression Inventory (NDDI-E) and Generalized Anxiety Disorders-7 (GAD-7) instruments, which are administered at every visit in our Epilepsy Center. We also asked whether respondents thought that they could predict their seizures to determine if stress as a seizure precipitant was correlated with seizure self-prediction.
  
  
  RESULTS
  Two hundred sixty-six subjects were included: 219 endorsed stress as a seizure precipitant [STRESS (+)] and 47 did not [STRESS (-)]. Among STRESS (+) subjects, 85% endorsed chronic stress as a seizure precipitant, and 68% endorsed acute stress as a seizure precipitant. In STRESS (+) subjects, 57% had used some type of relaxation or stress reduction method (most commonly yoga, exercise and meditation), and, of those who tried, 88% thought that these methods improved seizures. Among STRESS (-) subjects, 25% had tried relaxation or stress reduction, and 71% thought that seizures improved. Although univariate analysis showed multiple associations with stress as a seizure precipitant, in the multivariable logistic regression, only the GAD-7 score was associated with STRESS (+) (OR = 1.18 [1.03-1.35], p = 0.017). Subjects who reported stress as a seizure precipitant were more likely to report an ability to self-predict seizures (p < 0.001).
  
  
  CONCLUSIONS
  Stress-precipitated seizures are commonly reported by patients, may be associated with either acute stress or chronic stress, and are associated with higher scores on anxiety tests. Patients frequently use stress reduction methods to self-treat and report high success rates. A prospective, randomized trial of stress reduction for seizures is indicated.
authors.affiliation: Department of Neurology, Neuroscience Institute, University of Cincinnati, 260 Stetson St., Suite 2300, PO Box 670525, Cincinnati, OH 45267-0515, USA. Electronic address: michael.privitera@uc.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Privitera
authors.affiliation: Department of Neurology, Neuroscience Institute, University of Cincinnati, 260 Stetson St., Suite 2300, PO Box 670525, Cincinnati, OH 45267-0515, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Walters
authors.affiliation: Department of Neurology, Neuroscience Institute, University of Cincinnati, 260 Stetson St., Suite 2300, PO Box 670525, Cincinnati, OH 45267-0515, USA.
authors.forename: Ikjae
authors.initials: I
authors.lastname: Lee
authors.affiliation: Comprehensive Epilepsy Center, Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10463, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Polak
authors.affiliation: Department of Neurology, Neuroscience Institute, University of Cincinnati, 260 Stetson St., Suite 2300, PO Box 670525, Cincinnati, OH 45267-0515, USA.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Fleck
authors.affiliation: Department of Neurology, Neuroscience Institute, University of Cincinnati, 260 Stetson St., Suite 2300, PO Box 670525, Cincinnati, OH 45267-0515, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Schwieterman
authors.affiliation: Comprehensive Epilepsy Center, Department of Neurology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10463, USA.
authors.forename: Sheryl R
authors.initials: SR
authors.lastname: Haut
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D002908:Chronic Disease; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology* / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology
keywords: Anxiety; Depression; Epilepsy; Seizure; Stress