Psychological stress during wartime and its association with seizure-related emergency department utilization

Psychological stress is commonly reported as a seizure precipitant in epilepsy, yet evidence from major crises remains limited and inconsistent. We examined whether the October 2023 Israel-Hamas conflict affected acute seizure-related healthcare utilization among adults with epilepsy.

We conducted a retrospective cohort study of 34 941 adults with established epilepsy (International Classification of Diseases, Tenth Revision [ICD-10] G40 diagnosis ≥ 2 years prior) using the Clalit Health Services database in Israel. We compared seizure-related emergency department (ED) visits in two 1-year windows: pre-war (October 1, 2022-October 6, 2023) vs during-war (October 7, 2023-October 1, 2024). Primary outcome was ED visit rate per person-year. Given non-normal distributions, paired Wilcoxon tests assessed rate changes. Multivariable logistic regression identified predictors of worsening (during > pre), and Cox proportional hazards modeling evaluated time-to first ED visit, adjusting for demographics, socioeconomic status (SES), and comorbidities including dementia and post-traumatic stress disorder (PTSD).

Overall 3056 patients (8.8% of cohort) experienced a during-war ED visit. Cohort-level visit rates were similar across periods (224.13 vs 217.34 per 1000 person-years; rate ratio .97, 95% confidence interval [CI] .94-1.00). Among 1039 patients with ED visits in both periods, median within-patient change was negligible (-0.003 visits per person-year), but the distribution shifted toward lower wartime rates (Wilcoxon Z = -3.11, p = .002; paired t test p = .730). Dementia and older age were associated with the shift was toward lower wartime rates. Odds of worsening were negligibly higher with age (odds ratio [OR] = 1.007). Older age (hazard ratio [HR] = 1.03) and dementia (HR = 1.20) predicted earlier ED visits, whereas PTSD (HR = .73) and higher SES (HR = .82) reduced hazard.

War-related stress correlated with stable seizure-related acute care utilization, with minor redistribution among recurrent ED users. Older age and dementia identify vulnerable subgroups requiring enhanced monitoring during national emergencies. Targeted monitoring and clinical support for high-risk patients with epilepsy may help reduce acute seizure-related ED utilization during high-stress situations.