Stress and seizures: The October 7th experience

Stress is a frequently self-reported seizure trigger in patients with epilepsy (PWE), with studies regarding this issue having conflicting results. On October 7th, 2023, a large-scale military invasion accompanied by massive rocket launches against Israel, including Tel Aviv, occurred, providing an opportunity to investigate the role of acute stress in provoking seizures.

All adults who presented to the emergency department (ED) of Tel Aviv Sourasky Medical Center between January 1st, 2017, and February 29th, 2024, and were diagnosed with seizures were included. Data were collected using MDClone, a data acquisition tool. The overall seizure-related ED admissions were compared between October 7th^, 2023, to the end of February 2024, and the parallel period in prior years. Another analysis was performed across two periods: Immediate (first 30 days after October 7th^, 2023) and delayed (November 7- February 29) with a separate PWE analysis. A prophet model estimated expected vs. observed fraction of seizure-related ED visits of all-cause ED visits.

Among 352 patients who presented to the ED after the onset of stressful events and diagnosed with seizures, there was no difference regarding demographic variables, fractions of seizure-related ED visits (∼0.25%), hospital admissions or number of seizure-related ED visits compared to previous years, with a similar trend in the PWE analysis.

Based on ED visits to a large tertiary center, ED visit frequency did not increase following the October 7th events or the ongoing war, neither for new-onset nor recurrent seizures. Studies are required to evaluate long-term effects of acute and ongoing stress on ED visit frequency.