Which seizure-precipitating factors do patients with epilepsy most frequently report?
Introduction
Seizure susceptibility varies over time in most people with epilepsy. Although epilepsy is characterized by recurrent, unprovoked seizures, it is generally accepted that even though most seizures appear to occur spontaneously, they may be precipitated by a variety of endogenous or exogenous factors. Such seizure-precipitating factors have been defined as “those circumstances that precede the onset of an epileptic attack and are considered by both patient and neurologist to be a possible explanation for why the seizure happened when it did, and not earlier or later” [1]. According to Aird [2], seizure precipitants include both seizure-inducing and seizure-triggering factors. Inducing factors are of environmental or endogenous origin and cause a transient lowering of the seizure threshold, while triggering factors involve chemical or physiological stimulation capable of precipitating a seizure.
Seizure precipitants have received surprisingly little attention in the literature. Less than 1% of 30,000 epilepsy-related articles have dealt with seizure precipitants [2], despite the fact that the identification and avoidance of such factors and the development of specific countermeasures constitute an important and underestimated supplement to more traditional epilepsy therapies [2], [3]. The present study was designed to examine seizure-precipitating factors in a large epilepsy population and estimate the frequency of the precipitants most often reported by study subjects.
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Material and methods
As part of an ongoing study of seizures in twins ascertained from population-based twin registries in the United States, Denmark, and Norway, we identified 1677 twins and their relatives in whom it was possible to verify a history of epilepsy. For the purpose of this study, those with febrile seizures without subsequent epilepsy or whose seizures were classified as acute symptomatic or situation-related were excluded. The demographic and clinical characteristics of the study population are
Results
Among the 1677 subjects included in this study, 53% reported at least one seizure-precipitating factor, while 30% claimed that two or more such factors may have brought on a seizure (Table 3). The 10 most frequently reported precipitants are listed in Table 4. Emotional stress, sleep deprivation, and tiredness were the most frequently cited (20.9, 11.6, and 9.5%, respectively). Significant differences in the distribution of precipitating factors between the three populations were found for
Discussion
We believe that this large population-based sample is representative of epilepsy cases in general. The severity of disease among the participants varied considerably, i.e., from those with frequent, difficult-to-control seizures to those who have been seizure-free for many years and have been taken off medication. Thirty-nine percent of the population had active epilepsy, here defined as having experienced seizures the last 5 years and/or were still on AEDs.
There are several potential causes
Acknowledgment
This work was supported by a grant from the National Institute of Neurological Disorders and Stroke (NS31564).
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