Despite intensive pharmacological measures, seizures in 20 to 30 percent of persons with epilepsy are not adequately controlled. Furthermore, irrespective of level of seizure control, it is estimated that only 20 percent of seizures are attributable to particular triggering mechanisms; the remainder are viewed as occurring spontaneously, independently of any environmental factors or specific functional alteration of the body. Since, in efforts at seizure prevention, identification of triggering mechanisms is second in importance only to the discovery of basic etiologies and improved pharmacological management, exploration of possible psychosocial factors in seizure precipitation, especially among refractory patients, is long overdue. The proposed study requests continuation funds to test whether major life events (e.g., change of residence, death of a family member) are associated with change in seizure frequency. In addition, we aim to examine whether chronic role strains and chronic stress, social supports, and certain types of personal resources and coping responses, buffer seizures patients from the effects of stressful circumstances. The role of alcohol consumption, sleep loss and noncompliance with drug regimens in seizure frequency will also be examined, together with the question of whether seizure patients subgrouped by age, sex, seizure type, age of onset, and duration of disorder, show a differential vulnerability to event-precipitated seizures. With the exception of information on chronic stressors, personal resources, coping responses and the structure of social supports, data on independent and moderating variables and on seizure frequency were collected in a prospective manner by means of patient diaries. Patient compliance with anticonvulsant drug regimens was validated through assays of saliva and blood samples. Eighty subjects experiencing on average 2-3 seizures a week, adhered to the full study protocol for 10-12 weeks; 58 of these individuals maintained diaries for six month; 45 subjects for over 32 weeks. These data create the opportunity to examine the effect of psychosocial stresses on seizure frequency in a group of epileptics suffering from inadequately controlled seizures. It also offers the possibility of investigating the effect of a variety of factors in moderating the pathogenic effects of stress, an issue of major current concern in the stress field.
| Neugebauer, R; Paik, M; Hauser, W A et al. (1994) Stressful life events and seizure frequency in patients with epilepsy. Epilepsia 35:336-43 |
