Stress and epilepsy: a patient perception survey

doi:10.1016/S1525-5050(03)00182-3

Epilepsy & Behavior

Volume 4, Issue 5, October 2003, Pages 511-514

https://doi.org/10.1016/S1525-5050(03)00182-3 Get rights and content

Abstract

A questionnaire was administered to patients in the Montefiore Medical Center outpatient epilepsy department to assess perceptions about stress, seizures, and stress reduction. Eighty-nine patients completed the questionnaire. Overall, 64% of patients reported the belief that stress increased the frequency of their seizures. This belief was not significantly associated with gender, age, location of care, epilepsy classification, or seizure control, but was significantly associated with a shorter duration of epilepsy (P=0.04). Thirty-two percent of subjects had tried stress reduction modalities for epilepsy. Of those who had not, 53% were willing to try, and this willingness was significantly associated with a greater number of seizures in the prior 2 months (P=0.006) and the belief that stress was associated with seizures (P=0.04). Both major and minor stressors were reported with equal frequency. The majority of our study population believe that stress and seizures are related, and are willing to try stress reduction techniques for seizure control. We believe that these findings indicate a need for a prospective study to evaluate the role of stress and stress reduction as an additional potential therapeutic modality for epilepsy.

Introduction

Many patients with epilepsy report that stress exacerbates their seizures, but the association between stress and epilepsy is difficult to study. There are few objective measures of stress, and other factors such as fatigue and sleep deprivation must be considered [1], [2]. Nonetheless, if it can be reliably demonstrated that stress as an isolated factor does increase seizure frequency, then this may lead to a greater use of alternative treatments in epilepsy, including a variety of stress reduction modalities. As a preliminary step to a planned treatment trial of alternative therapies for epilepsy, this study was performed to explore and delineate patients’ perceptions of stress and specific stressors as related to seizure control.

Section snippets

Patient selection

Patients followed in the Epilepsy Management Center of Montefiore Medical Center were considered for inclusion in the questionnaire study if they met the following criteria: duration of epilepsy >1 year; age ⩾18; ability to read and complete an English or Spanish questionnaire. Of 96 eligible participants, 3 declined to participate, and 4 questionnaires were later excluded due to missing data.

Stress and seizures

Patients’ perceptions about the association between seizures and stress were addressed: “Have you ever

Demographic and epilepsy data

Eighty-nine subjects completed the questionnaire. Gender: female 59.5%; male 40.5%. Age: mean 38.2; range 18–25 (21.3%), 26–34 (19.1%), 35–50 (42.7%), and >50 (16.9%). Site of care: seizure clinic (46%), faculty practice (54%). Epilepsy classification: localization-related (87.6%), idiopathic/primary generalized (12.4%). Degree of seizure control: well-controlled (32.6%), not well-controlled (67.4%).

The association between stress and seizures

Overall, 57 of 89 (64%) subjects believed that some of their seizures were related to stress.

Discussion

Most studies of seizure precipitants identify stress as a frequent self-reported precipitant. Both stress levels [7] and major life events [8] have been reported in association with increased seizure frequency. Unfortunately, stress often coexists with other potential seizure precipitants, and the evaluation of stress as an independent factor is difficult, as was demonstrated by a questionnaire study of seizure precipitants by Mattson in 1991 [2]. Of 177 patients who completed a detailed survey

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Our findings that all stakeholder focus group participants overwhelmingly identified stress, stigma, financial issues because of disability policy, and medication side effects, as major barriers to epilepsy self-management, are consistent with those of studies of urban PLWE. In a study by Haut et al. [31] a patient perception survey about stress that was administered to a sample of PLWE (n = 89) outpatients at an urban medical center in New York city revealed that 64% of the PLWE reported the belief that stress increased the frequency of their seizures. Both major and minor stressors were reported with equal frequency.
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Stress is the seizure-precipitating factor most often described in epileptic patients [29,30], being also associated with one of the main causes of seizures [31,32]. Evidence also shows that 64% of epileptic patients reported increased frequency of epileptic seizures following stress [33]. Similar to humans, mice exposed to stressful conditions are more susceptible to seizures, showing reduced latency to seizures after PTZ challenge [34].
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^☆: Supported by NIH K23 NS02192-03 (P.I. Dr. Haut). Presented in part at the American Epilepsy Society Annual Meeting, December 2001, Philadelphia, PA, USA.

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Stress and epilepsy: a patient perception survey☆

Abstract

Introduction

Section snippets

Patient selection

Stress and seizures

Demographic and epilepsy data

The association between stress and seizures

Discussion

Seizure

Seizure

Distribution of seizure precipitants among epilepsy syndromes

Epilepsia

Emotional effects on seizure occurrence

Scaling of life events

Arch. Gen. Psychiatr.

Revised Epilepsy Stressor Inventory

J. Neurosci. Nurs.