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Are seizure precipitating factors underestimated in refractory epilepsies?

2008; Wiley; Volume: 49; Issue: 10 Linguagem: Inglês

10.1111/j.1528-1167.2008.01668.x

1528-1167

Péter Rajna, András Sólyom, László Mezőfi, Éva Vargyai,

Neuroscience and Neuropharmacology Research

EpilepsiaVolume 49, Issue 10 p. 1812-1813 Free Access Are seizure precipitating factors underestimated in refractory epilepsies? Péter Rajna, Péter Rajna Department of Psychiatry and PsychotherapyFaculty of Medicine, Semmelweis UniversityBudapest, HungarySearch for more papers by this authorAndrás Sólyom, András Sólyom National Institute of NeurosurgeryBudapest, HungarySearch for more papers by this authorLászló Mezőfi, László Mezőfi Department of Neurology"Kaposi Mór" County HospitalKaposvár, HungarySearch for more papers by this authorÉva Vargyai, Éva Vargyai Department of Neurology"Markhot Ferenc" County HospitalEger, HungarySearch for more papers by this author Péter Rajna, Péter Rajna Department of Psychiatry and PsychotherapyFaculty of Medicine, Semmelweis UniversityBudapest, HungarySearch for more papers by this authorAndrás Sólyom, András Sólyom National Institute of NeurosurgeryBudapest, HungarySearch for more papers by this authorLászló Mezőfi, László Mezőfi Department of Neurology"Kaposi Mór" County HospitalKaposvár, HungarySearch for more papers by this authorÉva Vargyai, Éva Vargyai Department of Neurology"Markhot Ferenc" County HospitalEger, HungarySearch for more papers by this author First published: 01 October 2008 https://doi.org/10.1111/j.1528-1167.2008.01668.xCitations: 1 [email protected] AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat To the Editors: Accurate evaluation of the influence of occasional seizure precipitating factors (SPF) in the clinical manifestation and course of epilepsy presents the researcher with a dilemma. On the one hand, lack of provoked seizures is one of the basic conditions for a diagnosis of epilepsy; on the other hand, the epileptic brain must be particularly sensitive to any phasic epileptogenic factors. In spite of a lack of strict medical evidence, experts have a great deal of information on the subjective significance of SPF in many patients. In some recent questionnaire-based surveys the majority of patients (or relatives) signalized at least one SPF preceding their habitual seizures (da Silva Sousa et al., 2005; Nakken et al., 2005; Sperling et al., 2007). The subjective nature of the patients' experiences means significant limitations of reliability of such studies. We recently obtained longitudinal data for 1,078 patients, including 4,012 control visits, equal to about 1,500 "patient-year" from the EPIMED 3.0 Hungarian Epilepsy Database (HED) (Rajna et al., 2001). The HED contains very detailed subdirectories for precipitants and provoking factors (Table 1). To validate patients' answers, we required them to include (qualitatively) the ratio of precipitated and unprovoked seizures during each interval. This indexing method allowed us to evaluate the consistency of the patients' reported experiences (for making their opinion more objective). Table 1. Subdirectories of Hungarian Epilepsy Database concerning seizure precipitants Sleep–wakefulness Alcohol Drug Somatic illness Sleep decrease Alcohol consumption Decrease in blood Circulatory disease Sleep increase Alcohol abuse Toxicity Liver disease Sleep disorder Alcoholic depression Other Kidney disease Keeping awake Other Fever Other Other Biological causes Endocrine causes Meteorology Life event Other Insolation Premenstrum Cold front Exhaustion … … Starvation Menstruation Warm front Emotional effect Hypoglycemia Ovulation Frontal change Psychic stress Thirst Involution Spring Other Dehydration Pregnancy Summer Water toxicity Lactation Autumn Other Contraception Winter Menopause Other Puberty Other Of the total population, 34% were sensitive to one or more precipitants. We found five meaningful SPF that provoked the patients' "habitual" seizures. Among these, unexpected life events (29.6%) and changes in drug intake (23.7%) were the most frequent SPF; presence of insomnia was observed in 20%, meteoropathological effects in 17% and alcohol consumption in 9.5% of the patients. Subgroups of epilepsies, seizure types, and severity and their regards to SPF were also treated statistically. No significant differences were shown among the subpopulations. There may be a smaller subgroup of patients in whom the applied antiepileptic treatment can eliminate only the risk of the unprovoked seizure because they are specially vulnerable to stronger or combined SPF. We have some 50 patients (5.5% of the population) belonging to this subpopulation. Patients who experienced one or more SPF in at least half of the intervals between two medical appointments were included in this target population ("seizure precipitant responders"). In our opinion optimal antiseizure therapy for these patients (and perhaps others), should include both increased efforts to recognize SPF and special therapeutic strategies for their avoidance or compensation, in addition to traditional pharmacotherapy or epilepsy surgery. Such treatment would increase the therapeutic potential and can help produce a better quality of life for the patients (at least in "responders"). Furthermore the approach provides new possibilities for the patients to contribute to their own therapeutic process. Conflict of interest: 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. None of the authors has any conflict of interest to disclose. References Nakken KO, Solaas MH, Kjeldsen MJ, Friis ML, Pellock JM, Corey LA. (2005) Which seizure-precipitating factors do patients with epilepsy most frequently report? Epilepsy Behav 6: 85– 89. Rajna P, Veres J, Csibri É, Sólyom A, Mizsér P, Téby A, Kozma L. (2001) EPIMED 3.0—Hungarian Epilepsy Database and Patient Documentation System (Hun). Ideggyogy Szle 54: 271– 282. Da Silva Sousa P, Lin K, Garzon E, Sakamoto AC, Yacubian EM. (2005) Self-perception of factors that precipitate or inhibit seizures in juvenile myoclonic epilepsy. Seizure 14: 340– 346. Sperling MR, Schilling CA, Glosser D, Tracy JI, Asadi-Pooya AA. (2007) Self-perception of seizure precipitants and their relation to anxiety level, depression, and health locus of control in epilepsy. Seizure. (Published online: Oct 30; 17977026). Citing Literature Volume49, Issue10October 2008Pages 1812-1813 ReferencesRelatedInformation