Stress could be a powerful trigger of epileptic seizures

Written by Jonathan Wilkinson

A review article published in the journal Seizure has examined the relationship between stress levels and seizures, reporting that the adoption of certain stress-reduction techniques may provide benefit as a low-risk form of treatment.
The stress–seizure relationship has been well documented for over half a century; as well as causing an increase in seizure susceptibility and a form of reflex epilepsy, it can also increase the risk of developing epilepsy in the first place. The authors of this article are affiliated with the University of Cincinnati Epilepsy Center at the UC Gardner Neuroscience Institute (OH, USA).

Michael Privitera (UC Gardner Neuroscience Institute), one of the review authors, commented on the efforts so far to understand the stress–seizure relationship: “Studies to date have looked at the relationship from many angles. 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 authors of this new paper looked at 21 studies conducted from the 1980s to the present day. The kinds of studies included involved patients who kept diaries of stress levels and correlation of seizure frequency, tracking of seizures after major life events, and fMRI studies that looked at responses to stressful verbal/auditory stimuli.

Privitera explained the findings: “Most 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.”

As an example, a study published in 2002 evaluated the occurrence of epileptic seizures during the war in Croatia in the early 1990s. It was found that children from war-affected regions experienced epileptic seizures more often than those who were not affected by the war.

Heather McKee (UC Gardner Neuroscience Institute), the other author of the study, commented: “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.”

Another important finding was higher anxiety levels in patients with epilepsy who report stress as a seizure precipitant. The researchers suggest that patients who believe stress may be a trigger for their epilepsy should be screened for mood disorders.

The study authors believe that while some small prospective trials have shown promising results for improving epilepsy using stress-reduction techniques, large-scale, randomized, controlled trials are required in order for these methods to become standard adjunctive treatments for people with epilepsy. Low-risk reduction techniques can include controlled deep breathing, relaxation or mindfulness therapy, as well as exercise. The authors think that the adoption of these techniques could improve overall quality of life and reduce seizure frequency for epilepsy patients at little to no risk.

Sources: McKee HR, Privitera MD. Stress as a seizure precipitant: identification, associated factors, and treatment options. 44, 21–26 (2017);