Seizure precipitants in a community-based epilepsy cohort

Abstract

Epileptic seizures can be provoked by several factors. Better understanding of these factors may improve a patient's sense of control and could reduce seizures. In daily practice, the recognition of seizure precipitants relies heavily on clinical or video-EEG evidence, which can be difficult to obtain. Studies of seizure provocation are largely based on selected hospital-based patient populations, which may lead to biased occurrence estimates. Self-reported seizure precipitants are rarely studied, yet are necessary to understand the experiences of patients and improve epilepsy management. We performed a cross-sectional community-based study of 248 epilepsy patients, selected by pharmacy records of anti-epileptic drug use. Self-reported seizure precipitants and potential associated characteristics were assessed using questionnaires. Almost half of all patients (47 %) reported one or more seizure precipitants, of which stress, sleep deprivation, and flickering lights were the most common. In this community-based setting, light-provoked seizures were especially frequent compared to the literature. Idiopathic generalized epilepsy (IGE), a lower age at seizure onset, and having auras or prodromes were found to be important independent prognostic factors associated with provoked seizures. IGE and a younger age at seizure onset have been linked to provoked seizures in earlier reports. The finding of auras or prodromes as a prognostic factor was unexpected, though case reports have described provoked seizures in patients having auras. Assessment of these factors may facilitate the early recognition of seizure precipitants in daily clinical practice. This is important for the optimization of epilepsy management for a large group of patients, as provoked seizures are expected to occur frequently.

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Acknowledgments

This study was funded by the National Dutch Epilepsy Foundation. The funders had no role in design, collection, analysis, or interpretation of the data, nor in the writing of the report or the decision to submit the article for publication. Researchers were independent from the funders.

Conflicts of interest

All authors declare no conflict of interests. A grant provided by the National Dutch Epilepsy Foundation was received for the conduct of the OPPEC study that forms part of the submitted work. All authors have no financial relationship with any organization that might have an interest in the submitted work or relationships or activities that could appear to have influenced the submitted work.

Ethical statement

We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. The study has been approved by the local ethics committee and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Correspondence to Merel Wassenaar.

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On behalf of the OPPEC study group.

Members of this group are listed in the Appendix section.

Appendix

Appendix

The following are members of the OPPEC study group in alphabetical order: J A. Carpay (M.D., Ph.D.), A C.G. Egberts (Ph.D.), G.J. de Haan (M.D., Ph.D.), D.G. Kasteleijn-Nolst Trenité (M.D., Ph.D.), B.P. Koeleman (Ph.D.), F.S.S. Leijten (M.D., Ph.D.), P. van der Linden (Ph.D.), D. Lindhout (Ph.D.), K.G.M. Moons (Ph.D.), S.G. Uijl (Ph.D.), M. Wassenaar (M.Sc.), I. Wilting (Ph.D.) all residing in the Netherlands, and J.W. Sander (M.D., Ph.D.) (United Kingdom). All members of the OPPEC study group were involved in the design of the study. MW was responsible for the design/conceptualization of the study, the collection, analysis, and interpretation of the data and for drafting the manuscript. DK, GdH, JC, and FL were responsible for the design/conceptualization of the study, revising the manuscript for intellectual content and for final approval of the version to be published. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

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Wassenaar, M., Kasteleijn-Nolst Trenité, D.G.A., de Haan, GJ. et al. Seizure precipitants in a community-based epilepsy cohort. J Neurol 261, 717–724 (2014). https://doi.org/10.1007/s00415-014-7252-8

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Keywords

  • Epilepsy
  • Seizure precipitants
  • Provoked-seizures
  • Community-based