Stress-7508650It’s been well documented that stress is the most common seizure precipitant for people with epilepsy. But little is known about the specific stressors, the timing of the stressors and other associated factors for stress-precipitated seizures.

If investigators could have such information, says Michael Privitera, MD, it could help in the design of large-scale randomized controlled trials of stress reduction interventions for epilepsy.

Privitera, a professor in the UC Department of Neurology and Rehabilitation Medicine and director of the Epilepsy Center at the UC Neuroscience Institute (UCNI), and colleagues at UC and Albert Einstein College of Medicine in New York surveyed a study population drawn from the Epilepsy Center at UCNI to identify patients who felt that their seizures were sometimes precipitated by stress and determined whether other epilepsy or mood factors were associated with stress-related seizures. They also asked participants if they had used stress reduction methods in the past and what effect stress reduction had on their seizures.
The research appears online in Epilepsy & Behavior, an international journal focusing on peer-reviewed articles based on laboratory and clinical research. Portions of the work were supported by a gift from the Shor Foundation for Epilepsy Research.
“Our goal was to determine mood and epilepsy characteristics of people who report stress-precipitated seizures,” says Privitera. “We are also interested in anxiety—is it a trait related to the tendency to report stress-induced seizures, or is anxiety itself a seizure precipitant?”
The study population was drawn the Epilepsy Center of the UC Neuroscience Institute, with outpatient clinics at two sites (Clifton and West Chester). Patients who agreed to participate filled out a questionnaire that included questions such as:
• “Do you believe that stress, especially emotional stress, makes a seizure more likely?”
• “Do you think that reducing your stress will reduce the number of seizures you experience?”
• “Have you ever tried any methods of stress reduction?”
• “Do you believe that any of the stress reduction methods you have tried helped reduce the number of seizures you experienced?”
Of the 266 subjects in the study, 219 (82.3 percent) endorsed stress as a seizure precipitant. Those who endorsed stress as a seizure precipitant were more likely (51.8 percent vs. 14.3 percent) to believe that they could at least occasionally predict seizures.
Among those who endorsed stress as a seizure precipitant, 85 percent endorsed chronic stress, and 68 percent endorsed acute stress (there was some overlap). Some type of relaxation or stress reduction treatment was used by 57 percent of the subjects who endorsed stress as a seizure precipitant, and 88 percent thought that it improved (i.e., reduced) seizures.
“Interestingly,” Privitera says, “of those who did not endorse stress as a seizure precipitant, 25 percent had tried relaxation or stress reduction, and 71 percent thought their seizures improved.”
The most common stress reduction methods, according to the study, were yoga, exercise and meditation, with more than one method used by most respondents.
As for the role of anxiety, Privitera notes that the ongoing SMILE (Stress Management Intervention for Living with Epilepsy) study, of which he is principal investigator for the Cincinnati site, uses daily electronic diaries to record subjects’ moods.  Results are expected to be published in early 2015.
“This will provide additional data that may help in deciphering the complex relationship between stress, anxiety, depression and seizure frequency,” Privitera says.