High levels of stress can trigger seizures in patients with known epilepsy and may even increase the risk of developing the condition, especially when stressors are severe, prolonged, or experienced early in life, according to the findings of a new review published in the European journal Seizure.
For the review, researchers at the University of Cincinnati (UC) Epilepsy Center analyzed 21 studies from the 1980s until now that looked into the stress-seizure connection and whether or not stress-reduction techniques could lower seizure incidence.
“Studies to date have looked at the relationship from many angles,” says Michael Privitera, M.D., director of the UC Epilepsy Center and professor in the Department of Neurology and Rehabilitation Medicine at the UC College of Medicine.
“The earliest studies from the 1980s were primarily diaries of patients who described experiencing more seizures on ‘high-stress days’ than on ‘low-stress days.'”
Privitera and Heather McKee, M.D., an assistant professor in the Department of Neurology and Rehabilitation Medicine, looked at 21 studies from the 1980s to present day, including those of patients who kept diaries of stress levels and correlation of seizure frequency, studies that tracked seizures after major life events, and fMRI studies that looked at responses to stressful verbal/auditory stimuli.
“Most all [of these studies] show increases in seizure frequency after high-stress events. Studies have also followed populations who have collectively experienced stressful events, such as the effects of war, trauma or natural disaster, or the death of a loved one,” Privitera said. All of these studies showed increased risk of seizures during such times of stress.
For example, a 2002 study looked at the incidence of epileptic seizures during the war in Croatia in the early 1990s.
Children from war-affected areas had epileptic seizures more often than those not affected by the war. In addition, the 10-year follow up showed that patients who had their first epileptic seizure during a time of stress were more likely to have controlled epilepsy or even be off medication years later.
“Stress is a subjective and highly individualized state of mental or emotional strain. Although it’s quite clear that stress is an important and common seizure precipitant, it remains difficult to obtain objective conclusions about a direct causal factor for individual epilepsy patients,” said McKee.
The researchers also found higher anxiety levels among epileptic patients who reported stress as a seizure precipitant.
“Any patient reporting stress as a seizure trigger should be screened for a treatable mood disorder, especially considering that mood disorders are so common within this population,” McKee said.
The researchers report that although a few small trials have shown promise in improving outcomes in people with epilepsy, large-scale, randomized, controlled trials are needed to convince both patients and providers that stress reduction methods should be standard adjunctive treatments for people with epilepsy.
“What I think some of these studies point to is that efforts toward stress reduction techniques, though somewhat inconsistent, have shown promise in reducing seizure frequency. We need future research to establish evidence-based treatments and clarify biological mechanisms of the stress-seizure relationship,” said Privitera.
Still, he adds that stress reduction methods “could improve overall quality of life and reduce seizure frequency at little to no risk.”
Some low-risk stress reduction techniques may include controlled deep breathing, relaxation, or mindfulness therapy, as well as exercise, or establishing routines.