Stress Reduction Techniques Could Help Reduce Seizure Frequency

A new study published inSeizure, confirms that stress is a common seizure trigger in epilepsy and that stress reduction techniques may provide a beneficial low-risk treatment option.

Over the past 50 years, the relationship between stress and seizures has been well documented. Furthermore, it’s been noted that stress can increase seizure susceptibility and increase the risk of epilepsy development. This is particularly true when stressors are severe, prolonged, or experienced early in life.

“Studies to date have looked at the relationship from many angles,” said investigator Michael Privitera, MD. “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.’”

The investigators examined 21 studies, from the 1980s to present, of patients who kept diaries of stress levels and correlation of seizure frequency, to tracking seizures after major life events, to 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, Privitera said. “Studies have also followed populations who have collectively experienced stressful events, such as the effects of war, trauma or natural disaster, or death of a loved one. All of which found increased seizure risk during such a time of stress.”

In a 2002 study that evaluated the occurrence of epileptic seizures during the war in Croatia that took place in the early 1990s, findings showed that children from war-affected areas had epileptic seizures more often than children not affected by war. During the 10-year follow up, the results showed that patients who had their first epileptic seizure during a stressful time 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,” said investigator Heather McKee, MD. “Although it’s quite clear that stress is an important and common seizure precipitant, it remains difficult to obtain objective conclusions about a direct casual factor for individual epilepsy patients.”

In another aspect of the relationship between stress and seizures, the investigators found that patients with epilepsy who reported stress as a seizure precipitant had higher levels of anxiety. According to the authors, the findings suggest that patients who believe stress is a seizure trigger may want to consult with their health care provider about screening for anxiety.

“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.

There have been some small prospective trials that showed promise in improving outcomes in patients with epilepsy using general stress reduction methods. However, large, randomized, controlled trials are needed to convince patients and providers that stress reduction methods should be a standard adjunctive therapy for patients 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,” Privitera said. “We need future research to establish evidence-based treatments and clarify biological mechanisms of stress-seizure relationship.”

The authors noted that, overall, recommending stress reduction methods to patients with epilepsy could improve their overall quality of life and reduce the frequency of seizures at little to no risk.