Stressful life events and seizure frequency in patients with epilepsy

We tested whether unpleasant life events increased seizure occurrence in persons with epilepsy. Forty-six subjects maintained daily diaries for 10-36 weeks in which they recorded seizures and life events. Mean age of subjects was 39 years; 78% were female; 83% had complex partial seizures (CPS). On the average, subjects reported 3.3 seizures a week. Analyses first were conducted within each subject and then in the sample overall. For each person, we tested whether seizure frequency increased within 24 h of the occurrence of unpleasant events, using Poisson regression analyses that adjusted for daily antiepileptic medication, sleep duration and quality, alcohol intake, menstrual status, and pleasant events. Rarity of events precluded analyses in 9 subjects. Events increased seizure frequency in 5 subjects (14%) (p < 0.05). Events decreased seizure frequency in 2 subjects (p < 0.05). When individual risk ratios were aggregated across subjects, unpleasant events were significantly associated with seizure increase only in men (RR = 1.67, 95% Confidence interval 1.09, 2.54). However, this finding must be interpreted with caution because of the limited number of men in the sample. In other aggregate analyses, events and seizures were not associated in subjects grouped by seizure type, age of seizure onset, current age, ethnicity, educational level, or marital status. Identification of factors that distinguish patients with and without event-triggered seizures requires further study.