Distribution of seizure precipitants among epilepsy syndromes

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.