Purpose: Previous studies of patient-reported seizure precipitants have not
evaluated whether different epilepsy syndromes are differentially affected
.
Methods: Patients of a tertiary-care epilepsy center were consecutively sur
veyed with the use of a standardized questionnaire that lists precipitants
that might trigger or exacerbate seizures (alcohol, caffeine, fasting fatig
ue, fever or illness, flashing lights, heat or humidity, menstrual cycle, s
leep, sleep deprivation, emotional stress, unknown, or other). Patients wer
e classified into epilepsy syndromes according to International League Agai
nst Epilepsy criteria. Age and gender within groups defined by major precip
itants were compared. Pearson's correlation was performed to evaluate commo
n patterns of precipitants.
Results: Of 400 patients, 62% cited at least one precipitant. In order of f
requency, stress (30%), sleep deprivation (18%), sleep (14%), fever or illn
ess (14%), and fatigue (13%) were noted by at least 10% of patients. Stress
, fatigue, and sleep deprivation positively correlated, but sleep tended to
negatively correlate with other major precipitants. Rankings of precipitan
ts varied within epilepsy syndromes, with patients with temporal lobe epile
psy citing sleep infrequently compared with patients with other epilepsy sy
ndromes. Menstrual effects were ranked highly within major precipitants amo
ng women over age 12 and were especially noted by women with temporal lobe
epilepsy (28%).
Conclusions: Most patients with epilepsy identify a precipitant that trigge
rs or exacerbates seizures. The high correlation of stress, sleep deprivati
on, and fatigue suggests that they act through common mechanisms to worsen
seizure control. Through identification of the effect of both endogenous an
d exogenous precipitants among syndromes, more research and counseling can
be directed to specific precipitants.